[Libman-Sachs endocarditis and ischemic stroke : A case report]. / Endocardite de Libman-Sachs et accident vasculaire cérébral ischémique : à propos d'un cas.

Libman-Sacks endocarditis is a rare cardiac manifestation of anti-phospholipid syndromes, in which non-infectious thrombotic vegetations are found on the heart valves. Most patients are asymptomatic whereas the risk of thromboembolism is considerable. Diagnostic work-up is based on questioning and clinical examination data looking for extracardiac signs, biological data and also on imaging, and, above all, echocardiography. We report the case of a 47-year-old female patient with no known history who is admitted to hospital with paresthesia of the right hemi-body associated with dysarthria. Cerebral CT scan confirms a paraventricular ischemic stroke. The etiological work-up for stroke is negative except the transesophageal echocardiogram which reveals mitral valve vegetations. Further investigations lead to the diagnosis of Libman-Sacks endocarditis. Treatment with Coumadin is started, with a target INR of between 2 and 3, as recommended. The clinical course was favourable, with stable lesions on transoesophageal echocardiography carried out later.

[Performance of the 4-level probability score 4PEPS for the diagnosis of pulmonary embolism in a sub-Saharan African population : Data from the Pulmonary Embolism Registry of the Bogodogo University Hospital, Burkina Faso]. / Performance du score de probabilité à 4 niveaux 4PEPS pour le diagnostic de l'embolie pulmonaire dans une population d'Afrique subsaharienne : données du Registre des Embolies Pulmonaires du Centre Hospitalier Universitaire de Bogodogo, Burkina Faso.

OBJECTIVE: To evaluate the performance of the 4PEPS score in the diagnosis of pulmonary embolism at the University Hospital of Bogodogo from January 1, 2021 to July 31, 2023. METHODOLOGY: This was a cross-sectional descriptive and analytical diagnostic study, running from January 1, 2021 to July 31, 2023. It took place in the infectious and tropical diseases departments, including a pneumology unit and a cardiology unit, of the Bogodogo University Hospital. Patients of both sexes with suspected pulmonary embolism who had undergone CT scan were included. The 4PEPS score was calculated and dichotomized into probable and improbable. It thus constituted the diagnostic test. CT scan was the gold standard. The accuracy of the diagnostic test was judged by the area under the ROC curve. An area under the curve between 0.70 and 1 would mean that the score was moderately informative to perfect. RESULTS: Our study included 472 patients with suspected pulmonary embolism out of a total population of 1228 patients. Hospital prevalence was 21.7%. The mean age of patients was 54.3 years. Females accounted for 52.1% of cases, with a sex ratio of 0.93. The prevalence of pulmonary embolism in the different probability levels of the 4PEPS score was 13.3% for the very low level, 11.7% for the low level, 84.6% for the intermediate level and 93.3% for the high level. Sensitivity and specificity were 92.1% and 86.82% respectively. The positive and negative predictive values were 90.1% and 89.4% respectively. The area under the ROC curve was 0.91. CONCLUSION: In our study, the 4PEPS score showed good negative and positive predictive values. The use of this score will enable practitioners faced with diagnostic difficulties to make therapeutic decisions, reducing inappropriate prescriptions for thoracic angioscan.

[Molecular profiling in biliary tract cancers: A national practice survey of French platforms]. / Portrait moléculaire dans les cancers des voies biliaires : enquête nationale de pratique auprès des plateformes françaises.

INTRODUCTION: Molecular profiling has become essential in the management of patients with biliary tract cancer (BTC). The aim of this study was to evaluate the practices of French genetics platforms in the management of BTCs. METHODS: A survey was developed by a multidisciplinary group and distributed to each of the 28 French genetics platforms over a one-month period. RESULTS: Twenty-one platforms answered the survey (75%). A majority (62%) had performed more than 50 analyses for BTCs over the last two years, with an average turnaround time for results evaluated between 11 and 15 days for 62% of them. Three quarters (76%) of the platforms performed both DNA and RNA analysis, while a quarter (24%) performed RNA analysis only. A commercial panel was used by 50% of platforms for DNA analysis, and 80% for RNA. Panels included between 10 and 50 genes for 76% of platforms. All responding platforms systematically tested for IDH1 mutations, FGFR2 fusions and BRAF mutations. A majority systematically tested for HER2 amplification, MSI status and TP53 mutation (88%, 81% and 69% respectively). DISCUSSION: This national survey of French genetics platforms shows good performance and compliance with recommendations for molecular analysis. However, many medical, financial and organizational obstacles remain upstream of these platforms.

Fluorescence-Detected Two-Dimensional Electronic Spectroscopy of a Single Molecule.

Single-molecule fluorescence spectroscopy is a powerful method that avoids ensemble averaging, but its temporal resolution is limited by the fluorescence lifetime to nanoseconds at most. At the ensemble level, two-dimensional spectroscopy provides insight into ultrafast femtosecond processes, such as energy transfer and line broadening, even beyond the Fourier limit, by correlating pump and probe spectra. Here, we combine these two techniques and demonstrate coherent 2D spectroscopy of individual dibenzoterrylene (DBT) molecules at room temperature. We excite the molecule in a confocal microscope with a phase-modulated train of femtosecond pulses and detect the emitted fluorescence with single-photon counting detectors. Using a phase-sensitive detection scheme, we were able to measure the nonlinear 2D spectra of most of the DBT molecules that we studied. Our method is applicable to a wide range of single emitters and opens new avenues for understanding energy transfer in single quantum objects on ultrafast time scales.

Environmentally stable, adhesive, self-healing, stretchable and transparent gelatin based eutectogels for self-powered humidity sensors.

Intrinsic environmental and stability limitations of hydrogels have inhibited their practical applications as a flexible wearable device due to water evaporation or freezing in complex environments such as low temperatures and arid environments. In this work, a multifunctional gelatin based ionic conductive eutectogel with double network structure is designed via ternary deep eutectic solvent (DES) (acrylic acid (AA), choline chloride (ChCl) and ethylene glycol (EG)). In this system, the introduction of ethylene glycol (EG) can be used to dissolve gelatin. The resulting DESG eutectogel exhibited excellent adhesion, mechanical robustness, anti-freeze, anti-drying, and self-healing. Interestingly, the DESG gels showed high humidity sensitivity in a wide humidity detection range (11 %-83 %), which can be assembled as a self-powdered humidity sensor to monitor human mouth and nose breathing. This work is expected to bring new prospect to construct high performance humidity sensors using gelatin based humidity-responsive materials for a wide range of potential applications in respiratory diagnostics, sleep monitoring, electronic skin and wearable electronics.

Enhancing antibiotic prescribing practices at the main military training hospital of Tunis: A study of pharmaceutical interventions.

BACKGROUND: Bacterial infections have historically posed significant challenges until the discovery of antibiotics, which revolutionized infectious disease treatment. However, bacterial adaptation mechanisms over time have led to increased antimicrobial resistance, necessitating judicious antibiotic use. OBJECTIVES: This study aims to comprehensively analyze pharmaceutical interventions related to antibiotic prescriptions governed by antibiotic order forms to identify and rectify medication errors, optimizing antibiotic prescribing practices. MATERIAL AND METHODS: Approval for this research was obtained from the institutional review board of the Main Military Training Hospital of Tunis, Tunisia. A retrospective study was conducted at the main military training hospital of Tunis over 4 months. Pharmaceutical validation of antibiotic prescriptions through antibiotic order forms was conducted by a pharmacy resident. Pharmaceutical interventions were initiated upon detection of errors, and patient records were accessed through institutional software. RESULTS: Out of 1100 prescription forms analyzed, 41 pharmaceutical interventions were conducted for 7 antibiotics. Twenty-four percent of all interventions were related to antibiotic order forms, with the intensive care unit accounting for the highest number of errors. Under-dosage and prescription errors were common. CONCLUSION: Our pharmaceutical interventions related to antibiotic order forms are crucial for optimizing antibiotic therapy. Feedback mechanisms to healthcare teams are essential for enhancing prescription quality and patient care outcomes. Ongoing surveillance and improvement efforts are necessary to address medication errors and enhance antimicrobial stewardship.

Selective microextraction of erythrosine (E127) in foodstuffs using a new generation high-density type-V deep eutectic solvent.

A novel and selective (deep eutectic solvent) DES-based microextraction method was established for the first time, utilizing a synthesized new generation High-Density Type-V DES for monitoring the dye Erythrosine (E127) in various foodstuffs and drugs. Type-V DES was created from acetophenone and diphenylamine at 3:1 M ratio. The pH, DES amount, and vortex time were optimized using Box-Behnken Design (BBD) of Response Surface Methodology (RSM). The quadratic microextraction model with R2 = 0.9982 was obtained. The limit of detection, preconcentration factor and linear dynamic range were determined to be 12 µg/L, 50 and 41-4000 µg/L, respectively. Effects of matrix components were examined. The developed High-Density Type-V Deep Eutectic Solvent Microextraction (HD-V-DES-ME) method was applied to foodstuffs and drugs to monitor their E127 contents and subsequently validated by applying spiked tests to real samples, with recoveries ranging between 94 and 101 %. The indexes of environmental friendliness and practicality for the method were evaluated using the Analytical GREEnness metric approach tool (AGREE) and the Blue Applicability Grade Index tool (BAGI), respectively.

Lignin extraction from acacia wood: Crafting deep eutectic solvents with a systematic D-optimal mixture-process experimental design.

Lignin is a complex biopolymer whose efficient extraction from biomass is crucial for various applications. Deep eutectic solvents (DES), particularly natural-origin DES (NADES), have emerged as promising systems for lignin fractionation and separation from other biomass components. While ternary DES offer enhanced fractionation performance, the role of each component in these mixtures remains unclear. In this study, the effects of adding tartaric acid (Tart) or citric acid (Cit) to a common binary DES mixture composed of lactic acid (Lact) and choline chloride (ChCl) were investigated for lignin extraction from acacia wood. Ternary Cit-based DES showed superior performance compared to Tart-based DES. Using a combined mixture-process D-Optimal experimental design, the Lact:Cit:ChCl DES composition and extraction temperature were optimized targeting maximum lignin yield and purity. The optimal conditions (i.e., Lact:Cit:ChCl, 0.6:0.3:0.1 M ratio, 140 °C) resulted in a lignin extraction yield of 99.63 ±â€¯1.24 % and a lignin purity of 91.45 ±â€¯1.03 %. Furthermore, this DES exhibited feasible recyclability and reusability without sacrificing efficiency.

Ten-year clinical outcomes of everolimus- and biolimus-eluting coronary stents vs. everolimus-eluting bioresorbable vascular scaffolds-insights from the EVERBIO-2 trial.

Background: Bioresorbable vascular scaffolds (BVSs) have been developed as a potential solution to mitigate late complications associated with drug-eluting metallic stents (DESs) in percutaneous coronary intervention for coronary artery disease. While numerous studies have compared BVSs to DESs, none have assessed clinical outcomes beyond 5 years. Objectives: This study aimed to compare the 10-year clinical outcomes of patients treated with BVSs vs. DESs. Methods: The EverBio-2 trial (Comparison of Everolimus- and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable Vascular Scaffold) is a single-center, assessor-blinded, randomized controlled trial that enrolled 240 patients allocated in a 1:1:1 ratio to receive BVSs, everolimus-eluting stents, or biolimus-eluting stents (BESs). Clinical follow-up was scheduled for 10 years. Results: Clinical follow-up was completed in 222 patients (93%) at the 10-year mark. The rate of device-oriented composite events (DOCE) was 28% in the DES group and 29% in the BVS group (p = 0.72) at 10 years. Similarly, the rate of patient-oriented composite events (POCE) was 55% in the DES group and 49% in the BVS group (p = 0.43) at 10 years. Notably, the rate of myocardial infarction (MI) within the target vessel was 5% in the BVS group and 0% in the BES group (p = 0.04), while the rate of any MI was 10% in the BVS group and 2% in the BES group (p = 0.04). In addition, the rate of Academic Research Consortium (ARC) possible stent thrombosis was 3% in the BVS group and 0% in the DES group (p = 0.04). Conclusions: Over 10 years, the rates of clinical DOCE and POCE were similar between the BVS and DES groups but individual outcomes of stent thrombosis were higher (3%) in the BVS group compared to the DES group. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT01711931).

A Network Analytic Approach to Dissociation: New Insights from Clinical Data.

The transdiagnostic construct of dissociation, characterized by a disintegration of specific psychological functions such as consciousness, memory, identity, perception, body representation, and behavior, remains elusive to a unified conceptualization. Specifically, its dimensionality is a matter of ongoing controversy. Empirical approaches applying factor analyses to the Dissociative Experiences Scale (DES) have yielded inconsistent findings. This study adopts a novel methodological approach, utilizing Exploratory Graph Analysis (EGA) to address this issue. In a sample of 668 day-hospital patients undergoing psychotherapy for a variety of mental disorders, a Gaussian graphical model was estimated for the 28 items of the DES. Additionally, the stability of the results was ensured by bootstrap procedures. While both the original EGA and the bootstrap EGA suggested four dimensions, the structural consistency of this solution was low due to an instability of 12 items. After excluding 10 of these unstable items, re-analyses again revealed a four-factor structure, but boot EGA indicated that one factor had unsatisfactory structural consistency due to the multidimensionality of its two items. Upon removing these, our final network consisted of 16 items mapping onto 3 dimensions. Our study, using data from a diagnostically heterogeneous sample, replicates and extends previous findings on the dimensionality of dissociation as captured by the DES. The three dimensions identified correspond to segregated processes, derealization/depersonalization, and absorption. This solution aligns with a bipartite model of dissociation with two broader categories referring to either altered states of consciousness (often named detachment) or to non-integrated mental modules (labeled as compartmentalization).

Space-time cluster analysis and maximum entropy modeling of Peste des petits ruminants (PPR) in Türkiye.

Peste des petits ruminants (PPR) is an economically important highly serious transboundary disease that mainly occurs in small ruminants such as sheep and goats. The aim of this study was to identify the probability of risk and and space-time clusters of Peste des Petits Ruminants (PPR) in Türkiye. The occurrence of PPR in Türkiye from 2017 to 2019 was investigated in this study using spatial analysis based on geographic information system (GIS). Between these dates, it was determined that 337 outbreaks and 18,467 cases. The highest number of outbreaks were detected in the Central Anatolia region. It was determined that PPR is seen more intensely in sheep compared to goats in Türkiye. In this study, 34 environmental variables (19 bioclimatic, 12 precipitation, altitude and small livestock density variables) were used to explore the environmental influences on PPR outbreak by maximum entropy modeling (Maxent). The clusters of PPR in Türkiye were identified using the retrospective space-time scan data that were computed using the space-time permutation model. A PPR prediction model was created using data on PPR outbreaks combination with environmental variables. Nineteen significant (p < 0.001) space-time clusters were determined. It was discovered that the variables altitude, sheep density, precipitation in june, and average temperature in the warmest season made important contributions to the model and the PPR outbreak may be strongly related with these variables. In this study, PPR in Türkiye has been characterized significantly spatio-temporal and enviromental factors. In this context, the disease pattern and obtained these findings will contribute to policymakers in the prevention and control of the disease.

[Outpatient coronary angiography and angioplastie / why, how and for wich patients ?] / Coronarographie et angioplastie coronaire ambulatoire ; pourquoi, comment, pour quels patients ?

There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential.

[Which workup should be performed after a pregnancy complicated with vasculo-placental disorder?] / Quel bilan proposer après une grossesse compliquée de pathologie vasculo-placentaire ?

Vasculo-placental disorders include pregnancy complications resulting from placental dysfunction of vascular origin, i.e. pre-eclampsia, HELLP syndrome, intrauterine growth retardation (IUGR), placental abruption and stillbirth of vascular origin. Pre-eclampsia should be investigated for antiphospholipid syndrome (APS) in case of severe pre-eclampsia and premature delivery before 34 weeks of gestation. In addition to testing for APS, pathological report of the placenta can identify some anatomical predispositions to placental vascular malperfusion, as well as chronic placental inflammatory lesions and excess fibrin deposits. The latter two are associated with IUGR and recurrent stillbirth, reflecting a dysimmune process of maternal origin. The internal medicine and obstetrics consultation, organized two months after delivery, combines the postnatal visit with an assessment of the causes of vasculo-placental disorders, and enables to inform patients about the management of future pregnancies and their cardiovascular health.

[Role of cranioplasty in the management of decompressive craniectomies: Study of the Adolphe de Rothschild Foundation Hospital cohort over 7 years]. / Place de la cranioplastie dans la prise en charge des crâniectomies décompressives : étude de la cohorte de l'Hôpital Fondation Adolphe de Rothschild sur 7 ans.

OBJECTIVES: The objective of our study is to take stock of the cranioplasty implants used within our establishment. MATERIALS AND METHOD: We analyzed the patients files who underwent craniectomy followed by cranioplasty between 2017 and 2023, with at least 1 year of follow-up after cranioplasty (n=75). The data were extracted from the computerized patient file (DxCare®, Dédalus) and the pharmaceutical management tool for drugs and sterile medical devices (Pharma®, Computer Engineering). The sex ratio, indication for craniectomy, operating time, time between craniectomy and cranioplasty, complications and aesthetic result were statistically analyzed. RESULTS: The main indications are stroke (n=59; 78.5%) and aneurysms (n=7; 9.5%). Among the 75 patients, 52 benefited from the placement of a custom implant (PolyEtherEtherCetone/PEEK or Hydroxyapatite) and 23 from cementoplasty. The operating time was significantly shorter (P<0.05) for custom cranioplasty (1.93±0.61h vs. 1.62±0.53). Only 4 patients (5.3%) were not satisfied with the aesthetic result following the placement of a custom implant. A greater risk of infection was found in the context of cementoplasty (43% for cementoplasties vs. 25% for the custom implant, so χ2 (P=0.1095), this difference not being statistically significant. CONCLUSION: This collaborative work between the pharmacy and the adult neurosurgery department served to establish an initial register for monitoring patients who have undergone cranioplasty for whom the ideal implant remains to be determined.

Robust, transparent, self-healable, recyclable all-starch-based gel with thermoelectric capability for wearable sensor.

Conventional all-starch-based (ASB) gels are weak and lack ductility. The preparation of a robust ASB gel with multi-functionalities e.g., self-healing, anti-freezing, conductivity, and so forth, is highly desirable but challenging. Herein, a new kind of ASB gel was prepared by gelatinizing starch in urea and choline chloride solution (UC) with the aid of water. Its tensile strength was up to 1.08 MPa with a tensile strain of 313 %, and this value hardly changed after 10 days ageing. A high healing efficiency of 98 % can be achieved after 1 h of healing at room temperature, and the healed tensile strength reaches up to ca. 1.06 MPa, which is almost the highest value for ASB gel. The resultant ASB gel can surfer from bending and twisting at -80 °C. Moreover, ASB gel also exhibits excellent biocompatibility and biodegradability. In addition, UC endowed the ASB gel with ion conductivity, allowing it to be used as a flexible strain sensor to monitor human movement. The ion-conductive ASB gel also exhibited thermoelectric ability with a Seebeck coefficient of 2.5 mV K-1, which can be further improved to 5 mV K-1 with a maximum output voltage of 252 mV by introducing a gradient of ionic concentration.

La pharmacothérapie en fonction des gènes chez les enfants et les adolescents qui prennent des médicaments psychoactifs.

Les médicaments psychoactifs sont de plus en plus utilisés pour traiter les enfants et les adolescents ayant des troubles de santé mentale, mais la variabilité des réponses individuelles fait ressortir l'importance d'une médecine personnalisée. Les tests pharmacogénétiques sont un volet important d'un tel type de médecine. Le nombre d'entreprises de tests pharmacogénétiques commerciaux qui font la promotion de tests de ce genre et promettent un traitement efficace et individualisé des troubles de santé mentale se multiplie depuis quelques années. Les preuves scientifiques en appui à l'utilisation de la pharmacogénétique sont limitées, particulièrement dans les populations pédiatriques. Le présent point de pratique souligne les étapes qui orientent le recours à ces tests pour la prise de médicaments psychoactifs en milieu clinique et présente des ressources de soutien importantes. Il existe des directives cliniques sur les variants des pharmacogènes qui encodent les enzymes de métabolisation du cytochrome P450 (p. ex., CYP2C19, CYP2D6, CYP2C9), lesquels sont l'un des déterminants des concentrations pharmacologiques dans le sang et peuvent appuyer à la fois le choix du médicament et la stratégie posologique de certains antipsychotiques, antidépresseurs et antiépileptiques. Les effets indésirables de certains médicaments antiépileptiques (p. ex., la carbamazépine et la phénytoïne) sont associés à certains types d'antigènes d'histocompatibilité humaine et à des variants de l'ADN polymérase gamma (POLG; acide valproïque). Les données probantes sont limitées à l'égard des variants génétiques des protéines qui ciblent les médicaments, et c'est pourquoi il est difficile de déterminer quels patients présenteraient une réponse altérée au traitement à une concentration sanguine thérapeutique.

Améliorer la sécurité à vélo chez les enfants et les adolescents.

Le vélo demeure une activité populaire pour les enfants et les adolescents du monde entier; elle combine le plaisir de se déplacer rapidement et de nombreux avantages pour la santé et la société. Cependant, le vélo est également associé à un risque de blessures graves et de décès. Depuis dix ans, les recherches démontrent de plus en plus que l'amélioration de la sécurité des cyclistes dépend en grande partie de l'environnement dans lequel ils se déplacent et de mesures de sécurité individuelles comme le port du casque. Pour de nombreux enfants et adolescents, la pandémie a accru les possibilités de faire du vélo et, et elle ramené l'attention du public vers des infrastructures cyclables sécuritaires, telles que des voies cyclables réservées. Le présent document de principes passe en revue les données probantes en appui à des infrastructures cyclables plus sécuritaires pour les enfants et les adolescents, de même que les bienfaits du vélo pour la santé physique et mentale. Les avantages du transport actif chez les jeunes et l'influence de l'environnement bâti sur la sécurité et l'adoption du vélo sont exposés. Un aperçu des mesures que chacun peut prendre pour améliorer la sécurité à vélo est suivi de recommandations pour les cliniciens, la communauté des cyclistes, les parents et les décideurs.