Impact of thoracoabdominal imaging on diagnosis and management in patients with suspected infective endocarditis.

BACKGROUND: Embolic events (EEs) are a common complication of infective endocarditis (IE) and their presence can impact diagnosis and modify the therapeutic plan. The present study aimed to describe the role of thoracoabdominal imaging, either thoracoabdominal-pelvic Computed Tomography or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography, on diagnosis and management of patients with suspected IE. METHODS: This study was conducted at a university hospital, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. RESULTS: Among 966 episodes with suspected IE and thoracoabdominal imaging, 528 (55%) patients were asymptomatic. At least one EE was found in 205 (21%) episodes. Based on thoracoabdominal imaging findings, the diagnosis was reclassified from rejected to possible or from possible to definite IE in 6 (1%) and 10 (1%) episodes, respectively. Among the 413 patients with IE, at least one EE was found on thoracoabdominal imaging in 143 (35%) episodes. Together with the presence of left-side valvular vegetation >10 mm, the results of thoracoabdominal imaging established a surgical indication (prevention of embolism) in 15 (4%) episodes, 7 of which were asymptomatic. CONCLUSIONS: Thoracoabdominal imaging performed in asymptomatic patients with suspected IE improved the diagnosis in only a small proportion of patients. Thoracoabdominal imaging led to a new surgical indication (in association with left-side valvular vegetation >10 mm) in only a small percentage of patients.

Role of Cerebral Imaging on Diagnosis and Management in Patients With Suspected Infective Endocarditis.

BACKGROUND: Cerebral embolic events (CEEs) are common complications of infective endocarditis (IE), and their presence can modify diagnosis and therapeutic plans. The aim of the present study was to assess the role of cerebral imaging (Cer-Im) on diagnosis and management of patients with suspected IE. METHODS: This study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. CEEs and IE were defined according to modified Duke criteria of the European Society of Cardiology (ESC) guidelines. RESULTS: Among 573 patients with IE suspicion and Cer-Im, 239 (42%) patients had neurological symptoms. At least 1 CEE was found in 254 (44%) episodes. Based on Cer-Im findings, episodes were reclassified from rejected to possible or from possible to definite IE in 3 (1%) and 25 (4%) patients, respectively (0% and 2% in asymptomatic patients, respectively). Among the 330 patients with possible or definite IE, at least 1 CEE was found in 187 (57%) episodes. A new surgical indication (in association with left-side vegetation >10 mm) was established in 74/330 (22%) IE patients and 30/155 (19%) asymptomatic IE patients, respectively. CONCLUSIONS: Cer-Im in asymptomatic patients with IE suspicion showed limited potential for improving the diagnosis of IE. In contrast, performing Cer-Im in asymptomatic patients with IE may be useful for decision making, because Cer-Im findings led to the establishment of new operative indication for valvular surgery in one fifth of patients according to ESC guidelines.

Instant Controlled Pressure-Drop (DIC) for Volatile Compound Extraction and Bioethanol Production from Empty Aleppo Pinecones and Eucalyptus Chips: Process Optimization and Statistical Modeling.

Several plant species contain volatile compounds extracted as "essential oils" through different technologies. After essential oil extraction, the residual solid is a lignocellulosic solid waste. This work proposes the instant controlled pressure-drop (DIC) technology to autovaporize volatile compounds and modify the lignocellulosic matrix. Indeed, DIC technology is a thermomechanical process based on short-time/high-temperature and pressure pretreatment. It enhances the saccharification and fermentation process (SSF) for bioethanol production. A 3-variable design of experiments optimized the DIC processing parameters to reach 100% efficiency (EE) of volatile compound extraction using response surface methodology (RSM). Eucalyptus chips presented 50 volatile identified compounds after 7 min of DIC treatment. 1,8-Cineole, ß-phellandrene, aromadendrene, eudesmol, and spathulenol are the most important volatile compounds. The empty Aleppo pinecones delivered 32 volatile compounds in 5 min of DIC treatment, the most important of which were caryophyllene, nortricyclene, verbenol, and camphor. After the autovaporization extraction stage, solid fraction residues were hydrolyzed and fermented in the same stirred bioreactor, using SSF strategy for 72 h at 37 °C. The highest bioethanol yields reached 73.9% and 54.82% (g per 100 g DM) from eucalyptus chip and empty Aleppo pinecone, respectively.

[Cardiology: what's new in 2022]. / Cardiologie : ce qui a changé en 2022.

The year of 2022 was marked by many novelties in the fields of interventional cardiology, heart failure, electrophysiology, cardiac imaging, and congenital heart disease. These advances will certainly change our daily practice, on top of improving the diagnosis and treatment of many heart conditions. In addition, the European Society of Cardiology has updated its guidelines on pulmonary hypertension, ventricular arrhythmias and sudden death, cardiovascular assessment of patients undergoing non-cardiac surgery. The members of the Cardiology division of Lausanne University Hospital (CHUV) here present the publications which they considered to be the most important of the past year.

L'année 2022 a été marquée par de nombreuses nouveautés dans les domaines de la cardiologie interventionnelle, de l'insuffisance cardiaque, de l'électrophysiologie, de l'imagerie cardiaque et des cardiopathies congénitales. Ces progrès vont certainement faire évoluer notre pratique quotidienne, en plus d'améliorer le diagnostic et le traitement de nombreuses cardiopathies. Par ailleurs, la Société européenne de cardiologie a mis à jour ses recommandations portant sur l'hypertension pulmonaire, les arythmies ventriculaires et la mort subite ainsi que le bilan cardiologique avant une chirurgie non cardiaque. Les membres du Service de cardiologie du CHUV vous présentent ici les travaux qui leur ont semblé être les plus importants de l'année écoulée.

Optimization of Enzymatic Degreasing of Sheep Leather for an Efficient Approach and Leather Quality Improvement Using Fractional Experimental Design.

Leather industry is making significant contributions to economic development. However, it is notably leading to a serious environmental pollution. Recently, the enzyme technology developments offer new opportunities for enzymatic application in leather making. In the present investigation, microbial lipases were studied and used in degreasing process of sheep leathers. In order to optimize degreasing efficiency, a fractional experimental design with four parameters (enzyme source, processing stage, lipase amount, and degreasing duration) was used. Lipases A from Aspergillus niger, F from Rhizopus oryzae, R from Penicillium roqueforti, and AY from Candida rugosa were selected for leather degreasing. Enzymatic treatment of sheep skin was carried out during two stages of beamhouse operations: deliming-bating and pickling. Obtained results showed that enzymatic degreasing efficiency is higher than those obtained with the conventional process. Lipase F from Rhizopus oryzae demonstrated the most interesting hydrolysis with yields of 58.3% and 37.2% for delimed and pickled skins, respectively. An enzymatic degreasing process on pickled leather using 0.125% (w/v) of lipase F during 3.5 h is the most promising for an industrial application with a 76.03 of degreasing efficiency. Results of the physico-mechanical tests of leathers having undergone enzymatic treatment complied with industry requirement. The enzymatic treatment may be carried out in the same conditions as employed in leather manufacturing process. Results suggested that the enzymatic degreasing improves the leather quality and reduces the use of chemical compounds and surfactant.

Steam explosion (SE) and instant controlled pressure drop (DIC) as thermo-hydro-mechanical pretreatment methods for bioethanol production.

Lignocellulosic biomass can be considered as one of the largest sources for the production of renewable biofuels (bioethanol). It involves an enzymatic treatment capable of ensuring the depolymerization of cellulose into fermentable sugars, followed by the production of ethanol by appropriate bacteriological fermentation. Proper destruction of the compact natural structure of the biomass would allow an interesting intensification of the operation. Among the most prominent technical approaches, the steam explosion (SE) is the most famous. However, this high pressure-high temperature process implies too high energy consumption while leading to the generation of many non-fermentable molecules. In recent years, many studies have proposed the use of the Instant Controlled Pressure-Drop (DIC) texturing pretreatment as an effective alternative to SE for ethanol production. Therefore, in this manuscript, we propose to compare and discuss the fundamental principles and experimental results of these two operations, as presented in the relevant literature.

[Study of unexpectedly detected repolarization in a group of black athletes]. / Etude de la repolarisation chez les sportifs de race noire.

INTRODUCTION: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. METHODS: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. RESULTS: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. CONCLUSION: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.

Conservative Management of Isolated Superior Mesenteric Artery and Celiac Trunk Dissection: A Case Report and Literature Review.

Isolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.