[Drug-induced acute angle closure glaucoma]. / Quels sont les médicaments à risque de précipiter un glaucome aigu par fermeture de l'angle ?

Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred vision accompanied by headache, nausea and vomiting. These symptoms must be recognized as soon as possible, and the patient must be addressed, urgently, to an ophthalmologist for treatment. Many drugs may lead to an acute angle closure glaucoma in patients with risk factors. This article aims to remind the anatomical risk factors as well as the drugs that may induce an acute angle closure glaucoma. For a better understanding, this article will provide a brief reminder of the pathophysiological mechanism of acute angle closure glaucoma.

Le glaucome aigu par fermeture de l'angle, appelé communément crise de glaucome, est une urgence ophtalmologique pouvant potentiellement conduire à la cécité. Les symptômes sont assez bruyants, les manifestations les plus fréquentes sont une douleur oculaire et une vision floue accompagnées de céphalées, de nausées et de vomissements. Ces symptômes doivent être reconnus le plus rapidement possible afin de référer le patient chez un ophtalmologue pour une prise en charge urgente. Plusieurs médicaments peuvent précipiter la survenue d'une crise chez un patient prédisposé. Il convient donc de rappeler les facteurs de risque anatomiques ainsi que les médicaments pouvant précipiter un glaucome aigu par fermeture de l'angle. Pour une meilleure compréhension, cet article fait un rappel succinct des mécanismes physiopathologiques impliqués dans la survenue d'un glaucome aigu par fermeture de l'angle.

Spatial dependency of the PPG morphology at right carotid common artery.

PhotoPlethysmoGraphy (PPG) is ubiquitously employed in wearable devices for health monitoring. Photodiode signal inversion is observed in rare occasions, most of the time when the sensor is pressed against the skin. We report in this article such observations made at the right common carotid artery site. Indeed we have systematically observed a photodiode signal inversion when the PPG sensor is placed where the pulse is the best felt at the carotid. In addition to be inverted, the pulse is steeper during the systolic phase. Such inversion has implications in terms of pulse arrival time (PAT) measurements In our experiments, this causes a difference of 20 ms in the carotid PAT when measured at the absolute maximum slope. The mechanical and optical properties of tissues must be better accounted to explain the PPG signal morphology. Clinical Relevance- Understanding the role of mechanical tissue properties seems relevant in order to obtain more reproducible results in PPG signal analysis.

Assessing the contribution of diazotrophs to microbial Fe uptake using a group specific approach in the Western Tropical South Pacific Ocean.

Diazotrophs are often limited by iron (Fe) availability in the oligotrophic ocean. The Western Tropical South Pacific (WTSP) ocean has been suggested as an intense N2 fixation area due to Fe fertilizations through shallow hydrothermal activity. Yet, the Fe demand of diazotrophs in their natural habitat, where they cohabit with other microbial organisms also requiring Fe, remains unknown. Here we develop and apply a method consisting of coupling 55Fe uptake experiments with cell-sorting by flow cytometry, and provide group-specific rates of in situ Fe uptake by the microbial community in the WTSP, in addition to bulk and size fractionation rates. We reveal that the diazotrophs Crocosphaera watsonii and Trichodesmium contribute substantially to the bulk in situ Fe uptake (~33% on average over the studied area), despite being numerically less abundant compared to the rest of the planktonic community. Trichodesmium had the highest cell-specific Fe uptake rates, followed by C. watsonii, picoeukaryotes, Prochlorococcus, Synechococcus and finally heterotrophic bacteria. Calculated Fe:C quotas were higher (by 2 to 52-fold) for both studied diazotrophs compared to those of the non-diazotrophic plankton, reflecting their high intrinsic Fe demand. This translates into a diazotroph biogeographical distribution that appears to be influenced by ambient dissolved Fe concentrations in the WTSP. Despite having low cell-specific uptake rates, Prochlorococcus and heterotrophic bacteria were largely the main contributors to the bulk Fe uptake (~23% and ~12%, respectively). Overall, this group-specific approach increases our ability to examine the ecophysiological role of functional groups, including those of less abundant and/or less active microbes.

Evaluation of a dual-PPG system for pulse transit time monitoring.

This work presents a new dual-photoplethysmographic (PPG) system for pulse transit time (PTT) monitoring. An experiment has been set up in order to compare the PTT measurement between carotid and radial arteries from two systems: our physiological multimodal platform (PMP) and the Complior® tonometer. This work explores the comparison between such optical and mechanical modalities. The results show that the PPG device tends to overestimate the PTT (RMSE = 16 ms). Furthermore, both mechanical and optical signals have been superposed and demonstrated that pulse morphologies are quite similar.Clinical Relevance-Carotid-radial pulse wave velocity (PWV) is compared on a small cohort of subjects and significant differences are observed between optical and mechanical-based systems.

Artefact subspace reconstruction for both EEG and fNIRS co-registred signals.

Combining electroencephalography (EEG) to functional near-infrared spectroscopy (fNIRS) is a promising technique that has gained momentum thanks to their complementarity. While EEG measures the electrical activity of the brain, fNIRS records the variations in cerebral blood flow and related hemoglobin concentrations. However, both modalities are typically contaminated with artefacts. Muscle and eye artefacts, affect the EEG signals, while hemodynamic and oxygenation changes in the extracerebral compartment due to systemic changes (superficial layer) corrupt the fNIRS signals. Moreover, both signals are sensitive to sensor motion artefacts characterized by large amplitude. There are several well-established methods for removing artefacts for both modalities. The objective of this paper is to apply a common approach to denoise both EEG and fNIRS signals. Indeed Artifact Subspace Reconstruction (ASR) method, which is an automatic, online-capable and efficient method for deleting transient or large-amplitude EEG artefacts, can be a good alternative to also denoise fNIRS signals. In this paper, we first propose, a new more comprehensive formulation of ASR. Then, we study the effectiveness of the method in denoising both the EEG and fNIRS signals.

Aliasing affects ActiLife software raw accelerometry to count conversion from different sampling frequencies.

Accelerometry counts are widely used to quantify physical activity in an objective manner. ActiGraph™ accelerometers offer to record acceleration signal with different sampling frequency (fs). Nevertheless additional counts were shown to be computed by ActiLife software from acceleration signal with a sampling frequency fs>30 Hz compared to signal with default fs=30 Hz or multiple. This paper relies on the study of synthetic signals to point out the origin of this error and to recommend an adjusted method. A piecewise-frequency sinus time series (0-15 Hz) was generated at different sampling frequencies (fs=30, 50 and 100 Hz). The artificial acceleration raw signal was resampled to 30 Hz using different antialiasing lowpass filters before ActiLife count computation. The use of an antialiasing filter which did not properly attenuate aliasing replicas was found to induce aliasing frequencies within ActiLife bandpass filter which is the cause of extract activity counts. We were able to reproduce fictitious counts for acceleration around 10 Hz. A simple adjustment of antialiasing filter parameters allowed to avoid this problem. This study reproduces ActiLife counts processing from 50 and 100 Hz sampled signal. Count overestimations from fs=50 and 100 Hz signal were induced because of aliasing in the frequency bandwidth of the ActiLife count filter. This can be corrected by a relevant antialiasing filtering before ActiLife software processing or this can be done in high-level mathematical programing.

[Congenital ocular melanocytosis]. / L'image du mois. Mélanocytose oculaire congénitale.

Congenital oculodermal melanocytosis represents a unilateral accumulation of melanocytes in the episclera, sclera and uveal tract. Clinically, it manifests with iris heterochromia, episcleral and scleral pigmented patches, dark pigmentation of the trabecular meshwork and the fundus. This congenital disorder is a predisposing factor for uveal melanoma and chronic glaucoma. We report here the case of a Caucasian woman who presents some of these characteristics.

La mélanocytose oculaire congénitale représente une accumulation unilatérale de mélanocytes au niveau de la sclère, l'épisclère et l'uvée. D'un point de vue clinique, on peut retrouver une hétérochromie irienne, une pigmentation de l'épisclère, de la sclère, du trabéculum et du fond d'œil. Un risque majoré de mélanome uvéal et de glaucome chronique est retrouvé chez ces patients. Nous rapportons ici le cas d'une jeune patiente caucasienne qui présente certaines de ces caractéristiques cliniques de façon tout à fait asymptomatique.

Results of laparoscopic intragastric surgery.

BACKGROUND: Technological and operative advancements have allowed laparoscopic intragastric surgery (LIGS) to be applied in the treatment of superficial gastric or submucosal lesions. The aim of this study was to evaluate short- and long-term outcomes following LIGS. METHODS: From 2000 to 2013, 25 LIGSs were performed for superficial gastric lesions. Clinical records were reviewed retrospectively for peri-operative course and long-term outcomes with particular attention to the oncological follow-up for patients with malignant lesions. RESULTS: Nineteen (76%) lesions were located close to the EGJ, three (12%) in the lesser curvature, two (8%) in the posterior wall and one (4%) in the prepyloric-antral region. A multiport technique was used in 15 (60%) patients and a single-access approach in 10 (40%) patients. The median operative time was 140 (50-210) minutes. No conversion to open or conventional laparoscopic surgery was needed. Mortality was nil, and severe morbidity occurred in one (4%) patient. The median length of stay was 6 (3-10) days. Indications of LIGS were adenocarcinoma in 11 (44%) patients, gastrointestinal stromal tumors (GISTs) in 6 (24%) patients and benign lesions in eight (32%) patients. En bloc resection was obtained in 24 (96%) patients with R0 margins in 23 (92%) patients. After a median follow-up of 76 (26-171) months, recurrence was detected in 4 (36%) patients with advanced malignant adenocarcinoma. CONCLUSION: LIGS provides an interesting alternative to major gastric and EGJ resection when endoscopic resection is not suitable for highly selected patients with superficial gastric lesions.

Direct oral anticoagulants in the treatment of acute venous thromboembolism in patients with obesity: A systematic review with meta-analysis.

BACKGROUND: Direct oral anticoagulants' (DOAC) pharmacokinetics are affected by obesity. Their efficacy and safety in obesity (BMI≥30 kg/m2) and morbid obesity (BMI≥40 kg/m2) are still unclear in the treatment of venous thromboembolism (VTE). OBJECTIVES: To compare the efficacy/safety of DOAC versus vitamin K antagonist (VKA)/low molecular weight heparin (LMWH) for the treatment of VTE in patients with obesity and morbid obesity. The primary efficacy/safety outcomes were VTE recurrence and major bleeding (MB). Clinically relevant non-MB and mortality were also evaluated. METHODS: A systematic literature search (MEDLINE, EMBASE, CENTRAL, Web of Science) identified studies evaluating DOAC in the treatment of VTE in patients with obesity and reporting one of the outcomes. Relative risks (RR) and 95 % confidence intervals (CI) were estimated using the Mantel-Haenszel method. RESULTS: We included 21 studies (50,360pts) of which 16,150 patients had a BMI≥30 kg/m2 and 6443 patients had a BMI≥40 kg/m2. VTE recurrence was similar with DOAC compared to VKA/LMWH in patients with obesity (RR 1.03;95 %CI 0.93-1.15;p = 0.55) and morbid obesity (RR 1.06;95 %CI 0.94-1.19;p = 0.35). DOAC were also associated with a reduction in MB (RR 0.57;95 %CI 0.34-0.94;p = 0.03 and RR 0.71;95 %CI 0.50-1.00;p = 0.05 in patients with obesity and morbid obesity, respectively). Subgroup analyses comparing randomized controlled trials to observational studies showed consistent results. No difference was observed in regards of clinically relevant non-MB and mortality. CONCLUSION: There is no signal for differences in VTE recurrence in patients with obesity and morbid obesity treated with DOAC compared to VKA/LMWH, while DOAC likely reduce the risk of MB compared to VKA/LMWH.

Blood pressure measurement by coupling an external pressure and photo-plethysmographic signals.

This work presents a new technique for the noninvasive measurement of systolic blood pressure (sBP), mean blood pressure (mBP) and diastolic blood pressure (dBP) using photo-plethysmographic (PPG) sensors when an artery is exposed to an external pressure. Two sets of experiments were performed: a first study combining PPG with an oscillometric device and the second combining PPG with a force/pressure sensor. These two experiments enable the estimation of BP values. PPG results were found to be comparable to oscillometric results, with bias and precision errors of -0.81 and 5.26 for sBP, 1.12 and 5.61 for mBP and 1.67 and 9.09 for dBP (n = 28). Furthermore, amplification over the brachial-to-finger path was found to be 1.02 ± 0.08 for mBP (n = 20) confirming that mBP does not undergo any amplification along the arterial tree whereas, for sBP, an amplification of 1.20 ± 0.12 (n = 7) was found for green wavelength, 1.35 ± 0.09 (n = 6) for red wavelength and 1.36 ± 0.09 (n = 6) for infrared wavelength. Thus, amplification for sBP is bigger for red and infrared wavelengths compared to green one.

Post-remission therapy of adults aged 60 and older with acute myeloid leukemia in first complete remission: role of treatment intensity on the outcome.

Although complete remission (CR) is achieved in 50 to 70% of older fit patients with acute myeloid leukemia (AML), consolidation therapy in this age group remains challenging. In this retrospective study, we aimed to compare outcome in elderly patients treated with different post-remission modalities, including allogenic and autologous hematopoietic stem cell transplantation (HSCT), intensive chemotherapy, and standard-dose chemotherapy (repeated 1 + 5 regimen). We collected data of 441 patients ≥ 60 years in first CR from a single institution. Median age was 67 years. Sixty-one (14%) patients received allo-HSCT, 51 (12%) auto-HSCT, 70 (16%) intensive chemotherapy with intermediate- or high-dose cytarabine (I/HDAC), and 190 (43%) 1 + 5 regimen. Median follow-up was 6.5 years. In multivariate analysis, allo-HSCT, cytogenetics, and PS had a significant impact on OS and LFS. In spite of a more favorable-risk profile, the patients who received I/HDAC had no significantly better LFS as compared with patients treated with 1 + 5 (median LFS 8.8 months vs 10.6 months, p = 0.96). In transplanted patients, median LFS was 13.3 months for auto-HSCT and 25.8 months for allo-HSCT. Pre-transplant chemotherapy with I/HDAC had no effect on the outcome. Toxicity was significantly increased for both transplanted and non-transplanted patients treated with I/HDAC, with more units of blood and platelet transfusion and more time spent in hospitalization, but no higher non-relapse mortality. This study shows that post-remission chemotherapy intensification is not associated with significantly better outcome as compared with standard-dose chemotherapy in elderly patients for whom, overall results remain disappointing.

Long-Term Sheep Implantation of WIMAGINE®, a Wireless 64-Channel Electrocorticogram Recorder.

This article deals with the long-term preclinical validation of WIMAGINE® (Wireless Implantable Multi-channel Acquisition system for Generic Interface with Neurons), a 64-channel wireless implantable recorder that measures the electrical activity at the cortical surface (electrocorticography, ECoG). The WIMAGINE® implant was designed for chronic wireless neuronal signal acquisition, to be used e.g., as an intracranial Brain-Computer Interface (BCI) for severely motor-impaired patients. Due to the size and shape of WIMAGINE®, sheep appeared to be the best animal model on which to carry out long-term in vivo validation. The devices were implanted in two sheep for a follow-up period of 10 months, including idle state cortical recordings and Somato-Sensory Evoked Potential (SSEP) sessions. ECoG and SSEP demonstrated relatively stable behavior during the 10-month observation period. Information recorded from the SensoriMotor Cortex (SMC) showed an SSEP phase reversal, indicating the cortical site of the sensorimotor activity was retained after 10 months of contact. Based on weekly recordings of raw ECoG signals, the effective bandwidth was in the range of 230 Hz for both animals and remarkably stable over time, meaning preservation of the high frequency bands valuable for decoding of the brain activity using BCIs. The power spectral density (in dB/Hz), on a log scale, was of the order of 2.2, -4.5 and -18 for the frequency bands (10-40), (40-100), and (100-200) Hz, respectively. The outcome of this preclinical work is the first long-term in vivo validation of the WIMAGINE® implant, highlighting its ability to record the brain electrical activity through the dura mater and to send wireless digitized data to the external base station. Apart from local adhesion of the dura to the skull, the neurosurgeon did not face any difficulty in the implantation of the WIMAGINE® device and post-mortem analysis of the brain revealed no side effect related to the implantation. We also report on the reliability of the system; including the implantable device, the antennas module and the external base station.

[Pseudoxanthoma elasticum revealed by choroidal neovascularization]. / Pseudoxanthome élastique révélé par un néovaisseau choroïdien.

Pseudoxanthoma elasticum is a genetic disease caracterised by calcification and fragmentation of elastic fibers affecting primarily the skin, the eyes and the cardiovascular system. We report a case in which the diagnostic was delayed due to an atypical presentation, allowing us to discuss the clinical signs, especially ocular, as well as the diagnosis criteria of this rare pathology. There is no specific treatment to pseudoxanthoma elasticum. It is essential to diagnose it rapidly in order to avoid potentially dramatic systemic outcomes.

Le pseudoxanthome élastique est une maladie héréditaire caractérisée par la calcification des fibres élastiques du tissu conjonctif touchant particulièrement la peau, les yeux et le système cardiovasculaire. Nous rapportons un cas clinique diagnostiqué plus tardivement suite à sa présentation atypique, ce qui nous permet d'aborder les signes cliniques, particulièrement oculaires, et la prise en charge diagnostique de cette pathologie rare. En effet, il n'existe pas de traitement spécifique du pseudoxanthome élastique. Il est donc essentiel de poser rapidement un diagnostic afin d'éviter la survenue d'atteintes systémiques potentiellement sévères.

A multi-dimensional approach to the relationship between insight and aggressiveness in schizophrenia: Findings from the FACE-SZ cohort.

BACKGROUND: Aggressiveness is a stigma frequently associated with schizophrenia. The role of insight as a risk factor of aggressiveness remains contradictory; mainly because single measures of these states mask their complexity and heterogeneity. METHODS: This study was conducted on 666 patients aged 15 and above with a DSM-IV-TR diagnosis of schizophrenia spectrum disorder, drawn from the French national network of schizophrenia expert center database. Collected data comprised socio-demographics and standardized psychiatric assessments. Aggressiveness was evaluated using the Buss-Perry Aggression Questionnaire and insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and Birchwood Insight Scale (BIS). RESULTS: Hostility was the aggressiveness dimension the most strongly associated with SUMD insight dimensions. Patients aware of their illness were nearly twice as likely to show hostility than those seriously unaware (OR = 1.95, 95% CI.: 1.08-3.5), but not when further adjusting for depression. Similarly, those aware of the consequences of their illness and of their symptoms were more hostile. Patients moderately aware of illness consequences had a higher risk of both anger and physical aggressiveness than those unaware (OR = 2.63, 95% CI.: 1.42-4.86, OR = 2.47, 95% CI.: 1.33-4.60, respectively), even when adjusting for depression for anger. CONCLUSION: Our study confirms that a multi-dimensional approach to insight and aggressiveness is essential to understand the types of links between these clinical states. Insight may trigger the expression of an underlying hostile tendency, maybe via depression and self-stigmatisation. This should be taken into account in therapeutic approaches to improve insight.

Physical activity estimation from accelerometry.

Objective physical activity (PA) quantification is traditionally achieved using lightweight accelerometers accounting for activity frequency, intensity and duration. The accelerometer data are usually converted into activity counts and these counts can be used on their own to quantify the intensity and duration of a PA period or they can serve as features for energy expenditure computation or activity classification. This paper investigates the way how Actigraph counts are computed. Several points are discussed regarding bandpass filtering and amplitude non-linearities that may hamper some analysis. Experimental data were used 1) to assess reconstructed filter performances to replicate ActiGraph counts during an urban-circuit involving 20 subjects wearing an ActiGraph GT3X+ and 2) explain filter limitations (e.g. plateauphenomenon) thanks to a treadmill test with incremental speed (n=4). This study reproduces well ActiLife filter and reveals the impact of band-pass filtering on ActiLife count conversion. These results provide some keys to interpret knowingly ActiLife count based studies.

[Acute myopic shift call sign of hantavirus infection]. / Myopie aiguë : signe d'appel d'une infection à hantavirus.

Acute myopic shift may be the first symptom of a hantavirus infection. In Belgium, lethal infections are rare, but this illness has to be ruled out in the emergency room. The refractive shift has not clearly been explained yet. The ancillary tests to describe this phenomenon are not always performed. This article may help on how to manage and how to explore this disease.

Une myopisation aiguë peut s'avérer être le premier signe d'appel d'une infection par hantavirus. En Belgique, cette virose est rarement létale, mais elle nécessite une prise en charge hospitalière urgente. Le mécanisme exact du trouble visuel reste encore mal expliqué. Les examens complémentaires qui permettraient de décrire le phénomène ne sont pas toujours réalisés. Deux cas nous permettent de faire la lumière sur une meilleure prise en charge et sur les mécanismes à explorer.