No beneficial effect of bracing after anterior cruciate ligament reconstruction in a cohort of 969 athletes followed in rehabilitation.

OBJECTIVE: Compare the clinical outcomes of different knee braces in the early phase of rehabilitation after anterior cruciate ligament reconstruction (ACLR) in athletes. MATERIALS AND METHODS: We conducted a retrospective database study of athletes during early rehabilitation in a tertiary referral hospital between 1 February 2008 and 30 October 2010 after ACLR using bone patellar tendon bone (BPTB) or hamstring autograft. Differences in mid-patellar knee circumference, pain, and range of motion were assessed at admission. All patients followed the same rehabilitation protocol. Patients who had complications preventing them from following the assigned rehabilitation program were analyzed separately. Patients who completed their rehabilitation program were also assessed for thigh muscle atrophy, extension deficit≥2°, quality of walking, PPLP1 and subjective IKDC scores. The type and frequency of complications and their frequency was documented. The above-mentioned parameters were analyzed in 3 different groups: rigid brace in full extension, articulated brace (0°-90° for first 3 weeks then 0-120°) or no brace. RESULTS: The analysis included 969 patients. Rehabilitation started at 4.5±2.9 days after surgery and ended at 32.4±3.0 days postoperative. At the beginning, flexion was lower in patients with a rigid brace (P<0.01). There was no difference in the frequency or severity of complications between the three study groups, nor was there a significant difference in the clinical outcomes listed above. CONCLUSION: Postoperative bracing after ACLR has not beneficial effect on clinical outcomes and the complication rate. Patients who wore the rigid brace had limited flexion early on.

Concurrent central nervous system infective pathology in a severely immunocompromised patient.

To our knowledge and literature search, concurrent cryptococcal meningitis and neurosyphilis in a patient have rarely been reported. Here, we report a 37-year-old male with HIV infection presented with headache and dizziness for 5 days along with memory difficulty and personality changes for about 1 week. During the hospital stay, cryptococcal meningitis was confirmed with positive cerebral spinal fluid (CSF) cryptococcal antigen titer (1:320) and positive CSF culture. Diagnosis of neurosyphilis was made based upon CSF white blood cell count of 85 cells/µL, with CSF total protein of 87 mg/dL, reactive CSF treponemal antibody, and fluorescent treponemal antibody. The patient was treated with amphotericin B, flucytosine, fluconazole, and benzathine penicillin G, and the patient was recovered and discharged. HIV patients are at high risk of developing severe infections of the central nervous system. Awareness should be made not only to single infection but also for dual pathology for a better and life-saving management.

[Routine screening for CMV during pregnancy: practices assessment in Île-de-France]. / Dépistage systématique du CMV pendant la grossesse : évaluation des pratiques en Île-de-France.

OBJECTIFS: Congenital infection with cytomegalovirus (CMV) is the leading cause of materno-fetal viral infection in industrialized countries. It covers up to 1% of neonates with risk of sequelae. The recommendations of the National agency for accreditation and evaluation in health from 2004 does not support routine screening for CMV during pregnancy. Some maternity hospitals still practice this screening and the purpose of this work is to present an overview of this practice in Île-de-France. PATIENTS AND METHODS: We present a descriptive cross-sectional survey among 99 maternity hospitals of Île-de-France between July 30, 2011 to January 15, 2012. Data were collected using a questionnaire in most cases during a telephone interview. Ninety-one questionnaires were collected. The primary endpoint was the achievement or otherwise of this screening. RESULTS: Of the 91 maternity hospitals surveyed, 13 (14.3%) still were conducting this screening in 2012. This practice was a minority and unrelated to the status (public/private), obstetric-pediatric type or activity. DISCUSSION & CONCLUSION: According to recent literature data, this diagnosis should be proposed only in case clinical or ultrasound signs. Screening could be included as part of research protocol for a better understanding of this pathology. It is not recommended in France and pending the development of an effective vaccine, informing pregnant women about preventive measures appear to be the most effective measure. This will involve a wide dissemination of recommendations to general practitioners in first line in support of women in early pregnancy.

Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomised, double-blind, phase II trial.

BACKGROUND: Rivaroxaban is an oral direct factor Xa inhibitor that has been effective in prevention of venous thromboembolism in patients undergoing elective orthopaedic surgery. However, its use after acute coronary syndromes has not been investigated. In this setting, we assessed the safety and efficacy of rivaroxaban and aimed to select the most favourable dose and dosing regimen. METHODS: In this double-blind, dose-escalation, phase II study, undertaken at 297 sites in 27 countries, 3491 patients stabilised after an acute coronary syndrome were stratified on the basis of investigator decision to use aspirin only (stratum 1, n=761) or aspirin plus a thienopyridine (stratum 2, n=2730). Participants were randomised within each strata and dose tier with a block randomisation method at 1:1:1 to receive either placebo or rivaroxaban (at doses 5-20 mg) given once daily or the same total daily dose given twice daily. The primary safety endpoint was clinically significant bleeding (TIMI major, TIMI minor, or requiring medical attention); the primary efficacy endpoint was death, myocardial infarction, stroke, or severe recurrent ischaemia requiring revascularisation during 6 months. Safety analyses included all participants who received at least one dose of study drug; efficacy analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00402597. FINDINGS: Three patients in stratum 1 and 26 in stratum 2 never received the study drug. The risk of clinically significant bleeding with rivaroxaban versus placebo increased in a dose-dependent manner (hazard ratios [HRs] 2.21 [95% CI 1.25-3.91] for 5 mg, 3.35 [2.31-4.87] for 10 mg, 3.60 [2.32-5.58] for 15 mg, and 5.06 [3.45-7.42] for 20 mg doses; p<0.0001). Rates of the primary efficacy endpoint were 5.6% (126/2331) for rivaroxaban versus 7.0% (79/1160) for placebo (HR 0.79 [0.60-1.05], p=0.10). Rivaroxaban reduced the main secondary efficacy endpoint of death, myocardial infarction, or stroke compared with placebo (87/2331 [3.9%] vs 62/1160 [5.5%]; HR 0.69, [95% CI 0.50-0.96], p=0.0270). The most common adverse event in both groups was chest pain (248/2309 [10.7%] vs 118/1153 [10.2%]). INTERPRETATION: The use of an oral factor Xa inhibitor in patients stabilised after an acute coronary syndrome increases bleeding in a dose-dependent manner and might reduce major ischaemic outcomes. On the basis of these observations, a phase III study of low-dose rivaroxaban as adjunctive therapy in these patients is underway. FUNDING: Johnson & Johnson Pharmaceutical Research & Development and Bayer Healthcare AG.

Transient repressor effect of Fis on the growth phase-regulated osmE promoter of Escherichia coli K12.

Transcription of the gene osmE of Escherichia coli is osmotically inducible and regulated by the growth phase. Expression of osmE is directed by a single promoter, osmE (p), which is recognized by Esigma(70) and Esigma(s), two forms of RNA polymerase using, respectively, the sigma factors sigma(70) and sigma(s). Esigma(s) transcribes osmE (p) during entry into stationary phase. Esigma(70) is responsible for osmotic induction of osmE (p) during the exponential growth phase. In a search for proteins that can modulate osmE (p) expression in trans, we performed electrophoretic mobility shift experiments using a DNA fragment carrying osmE (p) and crude extracts from E. coli. One major retarded band was observed in these experiments. The Fis protein is responsible for this retarded band, and binds to several sites upstream and downstream of, and overlapping, the promoter region of osmE. In a fis mutant background, the kinetics of in vivo transcription of osmE (p) during growth demonstrated that Fis is not responsible for the repression of the promoter seen during early exponential phase. In contrast, expression of osmE (p) at elevated osmolarity during the mid-exponential growth phase is increased in the absence of Fis, demonstrating that Fis is able to act as a repressor in vivo at a particular stage of growth.

Mechanochemical ATPases and transcriptional activation.

Transcriptional activator proteins that act upon the sigma54-containing form of the bacterial RNA polymerase belong to the extensive AAA+ superfamily of ATPases, members of which are found in all three kingdoms of life and function in diverse cellular processes, often via chaperone-like activities. Formation and collapse of the transition state of ATP for hydrolysis appears to engender the interaction of the activator proteins with sigma54 and leads to the protein structural transitions needed for RNA polymerase to isomerize and engage with the DNA template strand. The common oligomeric structures of AAA+ proteins and the creation of the active site for ATP hydrolysis between protomers suggest that the critical changes in protomer structure required for productive interactions with sigma54-holoenzyme occur as a consequence of sensing the state of the gamma-phosphate of ATP. Depending upon the form of nucleotide bound, different functional states of the activator are created that have distinct substrate and chaperone-like binding activities. In particular, interprotomer ATP interactions rely upon the use of an arginine finger, a situation reminiscent of GTPase-activating proteins.

[In hospital and mid-term outcome of patients with NIR stent implantation: multicenter ESPORT-NIR registry]. / Evolución hospitalaria y a medio plazo en pacientes tratados con implante de stent NIR: experiencia del registro multicéntrico ESPORT-NIR.

BACKGROUND AND OBJECTIVE: Despite improvements in the results and techniques of catheter-based revascularization, few studies have evaluated the clinical results of the application of new stent designs. We describe the in-hospital and mid-term outcome of patients undergoing a stent NIR implantation. PATIENTS AND METHOD: At least 1 Stent NIR was implanted in 1.004 patients (1.136 lesions) recruited from 50 centers in an international, multicenter, prospective, registry (Spain and Portugal NIR stent registry). Inclusion criteria were objective coronary ischemia related to a severe de novo lesion or first restenosis in native vessels with a reference diameter >= 2.75 mm. The primary end-point was the incidence of major adverse cardiac events within the first 7 months of follow-up. RESULTS: The mean age of the patients was 60 years and 82% were male. Angioplasty was indicated due to unstable angina in 61% of the cases. Stent implantation was successfully achieved in 99.6%. Clinical success (angiographic success without in-hospital major events) was achieved in 98.6% of patients. The rate of angiographic restenosis (> 50% stenosis narrowing) was 16% (CI 95%; 11.7-21.2). The accumulated major cardiac adverse event rate at seven months of follow-up was 8.7%: death (0.9%), acute myocardial infarction (1.2%) and target lesion revascularization (6.6%). CONCLUSION: In the wide setting of the population included in the ESPORT-NIR registry, stent NIR implantation was a highly effective therapy with a good mid-term clinical and angiographic outcome.

[Repair of saphenous vein perforation with covered stent during angioplastic]. / Tratamiento con stent recubierto de una perforación de injerto de safena durante una angioplastia.

Coronary perforation or rupture is an infrequent complication of angioplasty which may have a poor prognosis and influence patient survival. Cardiac tamponade or the presence of ischemia leading to acute myocardial infarction may require emergency cardiac surgery. Surgical treatment of perforation or rupture of the coronary arteries is based on prolonged inflation with angioplasty balloons or autoperfusion. There are few studies on the placement of covered stents to seal the perforation. We present the case of a patient who presented saphenous vein graft rupture following high pressure stent implantation requiring percutaneous placement of a covered stent.

Characterization of OpuA, a glycine-betaine uptake system of Lactococcus lactis.

A Lactococcus lactis glycine-betaine transport system was identified by functional complementation of an Escherichia coli proP proU mutant with a gene library from L. lactis sbsp. cremoris. The cloned locus forms an operon highly homologous to opuA, encoding a glycine-betaine uptake system of Bacillus subtilis. Disruption of opuA in L. lactis abolished protection by glycine-betaine against elevated osmolarity. OpuA belongs to the so-called "ABC transporters" family, which comprise an extracellularly localized substrate-binding protein. In B. subtilis OpuA system, this binding protein is a lipoprotein, attached to the external face of the cytoplasmic membrane by its lipidic moiety. In contrast, in the L. lactis opuA operon, and in other gram-positive homologues as well, a fusion between the gene encoding the integral membrane protein and the substrate-binding protein components gave rise to a hybrid protein presumably attaching the substrate-binding protein to the surface of the cell via its covalent link to the integral membrane component. Mapping of L. lactis opuA transcription start identified one mRNA, more abundant in cells grown at elevated osmolarity. Construction of an opuA-gusA fusion confirmed that opuA transcription is directed by a promoter osmotically inducible in L. lactis. When recombined upstream from a lac transcriptional fusion in the chromosome of E. coli, the opuA promoter appeared as very strong, and only poorly stimulated by elevated osmotic pressure, suggesting the existence of a specific machinery involved in the osmotic signal transduction in L. lactis.

[Peripheral cholesterol embolism in a percutaneous coronary angioplasty procedure. A case report]. / Embolismo periférico de colesterol en un procedimiento de angioplastia coronaria percutánea. Presentación de un caso.

Cholesterol embolism is a rare but potentially serious complication of cardiac catheterization. We report the case of a patient who presented a cholesterol embolism in the lower extremities after percutaneous angioplasty and the elective implantation of a stent. Clinical evolution was favourable. The appearance of cholesterol embolism could have been precipitated, in this case, by anticoagulation treatment with heparin and intense antiaggregation.

Involvement of differential efficiency of transcription by esigmas and esigma70 RNA polymerase holoenzymes in growth phase regulation of the Escherichia coli osmE promoter.

Transcription of the gene osmE of Escherichia coli is inducible by elevated osmotic pressure and during the decelerating phase of growth. osmE expression is directed by a single promoter, osmEp. Decelerating phase induction of osmEp is dependent on the sigmas (RpoS) factor, whereas its osmotic induction is independent of sigmas. Purified Esigmas and Esigma70 were both able to transcribe osmEp in vitro on supercoiled templates. In the presence of rpoD800, a mutation resulting in a thermosensitive sigma70 factor, a shift to non-permissive temperature abolished induction of osmEp after an osmotic shock during exponential phase, but did not affect the decelerating phase induction. Point mutations affecting osmEp activity were isolated. Down-promoter mutations decreased transcription in both the presence and the absence of sigmas, indicating that the two forms of RNA polymerase holoenzyme recognize very similar sequence determinants on the osmE promoter. Three up-promoter mutations brought osmEp closer to the consensus of Esigma70-dependent promoters. The two variant promoters exhibiting the highest efficiency became essentially independent of sigmas in vivo. Our data suggest that Esigmas transcribes wild-type osmEp with a higher efficiency than Esigma70. A model in which an intrinsic differential recognition contributes to growth phase-dependent regulation is proposed. Generalization of this model to other sigmas-dependent promoters is discussed.

Acute and chronic changes in atrial natriuretic factor induced by ventricular pacing: a self controlled clinical trial.

A self controlled clinical trial was carried out to study the acute and chronic effects of ventricular pacing (VVI) on the atrial natriuretic factor (ANF). Eleven people were selected from a pool of 20 DDD paced patients. Pacemakers were programmed to the VVI mode for 1 month and their effectiveness tested by ECG at rest and after an effort test. AnF was measured by radioimmunoassay at baseline, after 15 minutes, and again 1 month after programming. The reliability of the radioimmunoassay was confirmed using the coefficients of variation between (12.5%) and within assay (9.7%). Data analysis was done using Wilcoxon's test. Our results showed that the onset of VVI pacing led to a sudden sharp rise in ANF in all patients (P < 0.0001). During VVI pacing, three patients were dropped from the study (2 were withdrawn because of symptoms and 1 voluntarily withdrew). After 1 month of VVI pacing, a significant increase of ANF above the baseline was observed (P < 0.05). The results showed that ventricular pacing led to an immediate rise in ANF and, that with long-term VVI pacing, there was an increase in ANF levels as well. The role of these findings in the pathophysiology of the pacemaker syndrome calls for further research.

Renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines.

OBJECTIVE: To evaluate the renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines. DESIGN: Prospective, clinical study using sequential periods. SETTING: A 12-bed surgical intensive care unit in a university hospital. PATIENTS: 14 patients with sepsis syndrome and 15 patients with septic shock treated with exogenous catecholamines were studied. They had no diuretic treatment. INTERVENTION: Two periods of 2 h each with and without 2 micrograms.kg-1.min-1 of dopamine infusion. Hemodynamic and renal data were obtained at the end of each period. Measurements were repeated after 48 h of dopamine infusion in patients with sepsis syndrome. All data were evaluated by the Wilcoxon rank test. MEASUREMENTS AND RESULTS: In patients with sepsis syndrome, diuresis and creatinine clearance increased significantly by 100% and 60%, respectively, during low-dose dopamine infusion without any change in systemic hemodynamics. The renal response to dopamine decreased significantly after 48 h of dopamine infusion (P < 0.01). In patients with septic shock treated with catecholamines, no variation of either systemic hemodynamics or renal function was noted during low-dose dopamine infusion. CONCLUSION: The renal effects of low-dose dopamine in patients with sepsis syndrome decrease with time. No renal effect of low-dose dopamine was observed in patients with septic shock treated with catecholamines. These findings suggest a desensitization of renal dopaminergic receptors.

[Percutaneous extraction of intravascular foreign bodies: a series of 38 cases]. / Extracción percutánea de cuerpos extraños intravasculares: una serie de 28 casos.

BACKGROUND AND OBJECTIVES: Retained foreign bodies or embolization in cardiac chambers is a relatively common clinical problem. As experience was acquired, it became apparent that failure to remove such fragments could result in morbility or mortality. In the past, surgical removal was the only method available. We present our experience of percutaneous extractions of embolized foreign bodies. The technical aspects are discussed. PATIENTS AND METHODS: Twenty eight cases (age between 1 and 80 years) of cardiac and intravascular foreign bodies seen in two hospitals are reported. Seventeen were plastic catheters or fragments (two were radiotransparent), 5 guide wires in vena cava, right atrial and ventricle, pulmonary artery and abdominal aorta, 4 patients had pacemaker electrodes in the right atrium or ventricle. Stent embolization was observed in two patients. The stents were stripped from the delivery catheter and removed from iliac artery. A pigtail catheter was sometimes used to remove the fragment found in the right ventricle. In 8 cases the capture and extraction was made using a loop snare with a 0.025 inch guide J-wire device folded in half at its midsection and inserted through a long introducer, and in another 20 cases a Dormia basket system was used. In all four patients with pacemaker electrodes, simple counteraction was used with a 10 F left coronary directional atherectomy guide catheter. RESULTS: In two patients removal was impossible--in one the pacemaker electrode was caught but not retrieved because was densely adhered to the endocardium for several years; in another a guide wire was found in a child one year old--. In the other 26 patients, foreign body extraction was performed percutaneously without any complication with a basket or snare; only in one case (a radiotransparent catheter) both systems were used. CONCLUSIONS: Percutaneous removal of centrally embolized foreign bodies, cardiac or vascular, is a safe and successful procedure. The basket system needs to be used more carefully.

[A single coronary artery exiting the left sinus of Valsalva: 3 different pathways of the right branch]. / Coronaria única saliendo del seno de Valsalva izquierdo: tres trayectos diferentes de la rama derecha.

Three old male patients with a single coronary artery from the left Valsalva sinus and three different origin of right branch (left anterior descending, left main and circumflex artery) are reported here; first and second patients, with an aberrant trayect of the right coronary artery. We describe anatomic and angiographic findings with a literature review.

[Long-term effects of cardiac pacing on natriuretic atrial peptide levels in patients with AV block]. / Efectos crónicos de la estimulación cardíaca sobre los niveles de hormona auricular natriurética en pacientes con bloqueo AV.

In this work we intend to analyze the long term effects of the classic modes of definitive cardiac pacing (VVI and DDD) on the atrial natriuretic peptide levels. A priori hypothesis is: the AV asynchrony raises the hormonal level. The design is a cross-sectional study, and the setting is the pacemaker doctor's room of a tertiary hospital. In 24 patients (17 VVI and 7 DDD) the atrial natriuretic peptide was determined by RIA. A multiple regression model was fitted to analysis. The basic result is: when several factors were controlled (age, sex, hypertension, and cardiac failure story), the atrial natriuretic peptide levels are increased in the VVI group. In conclusion, the lack of AV synchrony induced the increase of atrial natriuretic levels. For an endocrine viewpoint the DDD is more physiological pacing as well.

Influence of straw feeding and growth-implant on veal meat quality.

Trials have been carried out to examine the effects of a food additive supply (Maturex) and/or of anabolic implant (Revalor) on carcass characteristics and on veal meat qualities. Twelve Holstein × Française Frisonne Pie Noire calves acted as controls, twelve calves were implanted with Revalor, approximately 60 days prior to slaughter, twelve others were fed with Maturex, whilst the remaining twelve animals were fed with Maturex and implanted with Revalor. All animals were slaughtered at 4 months. Revalor implantation had a significant effect on carcass weight and conformation. Feeding with Maturex had no significant effect on different carcass characteristics. Neither anabolic treatment nor Maturex supplementation significantly affected pH value, haematocrit, pigment content, FOP, colour characteristics, collagen content and solubility, or dry matter. Although Revalor had a negative effect on weight losses during cooking, Maturex showed no significant effect. While Maturex showed a positive effect on tenderness and no effect on juiciness, Revalor showed a negative effect on tenderness and juiciness. For all sensory characteristics, no effect was noted when both Maturex and Revalor were used together.