Reactivation of Epstein-Barr virus among intensive care patients: a prospective observational study.

PURPOSE: Herpesvirus reactivation has been documented among patients in the intensive care unit (ICU) and is associated with increased morbidity and mortality, particularly for cytomegalovirus (CMV). Epstein-Barr virus (EBV) has been poorly studied despite >95% of the population being seropositive. Our preliminary study suggested an association between EBV reactivation and increased morbidity and mortality. This study aimed to investigate this association among patients admitted to the ICU. METHODS: In this multicenter prospective study, polymerase chain reaction was performed to quantify EBV in patients upon ICU admission and then twice a week during their stay. Follow-up was 90 days. RESULTS: The study included 129 patients; 70 (54.3%) had EBV reactivation. On day 90, there was no difference in mortality rates between patients with and without reactivation (25.7% vs 15.3%, p = 0.22). Patients with EBV reactivation at admission had increased mortality compared with those without reactivation and those with later reactivation. EBV reactivation was associated with increased morbidity. Patients with EBV reactivation had fewer ventilator-free days at day 28 than those without reactivation (18 [1-22] vs. 21 days [5-26], p = 0.037) and a higher incidence of acute respiratory distress syndrome (34.3% vs. 17%, p = 0.04), infections (92.9% vs. 78%, p = 0.03), and septic shock (58.6% vs. 32.2%, p = 0.004). More patients with EBV reactivation required renal replacement therapy (30% vs. 11.9%, p = 0.02). EBV reactivation was also associated with a more inflammatory immune profile. CONCLUSION: While EBV reactivation was not associated with increased 90-day mortality, it was associated with significantly increased morbidity.

Bothrops venom-induced hemostasis disorders in the rat: Between Scylla and Charybdis.

Hemostasis impairment represents the most threatening consequence of Viperidae envenoming, notably with Bothrops genus. In the French departments of America, B. atrox envenomation in French Guiana may lead to bleeding while B. lanceolatus envenomation in Martinique to thrombosis. Bleeding related to B. atrox envenomation is attributed to vascular damage mediated by venom metalloproteinases and blood uncoagulable state resulting from thrombocytopenia and consumptive coagulopathy. Thrombosis related to B. lanceolatus envenomation are poorly understood. We aimed to compare the effects of B. atrox and B. lanceolatus venoms in the rat to identify the determinants of the hemorrhagic versus thrombotic complications. Viscoelastometry (ROTEM), platelet count, plasma fibrinogen, thrombin generation assay, fibrinography, endothelial (von Willebrand factor, ADAMTS13 activity, ICAM-1, and soluble E-selectin), and inflammatory biomarkers (IL-1ß, IL-6, TNF-α, MCP-1, and PAI-1) were determined in blood samples obtained at H3, H6, and H24 after the subcutaneous venom versus saline injection. In comparison to the control, initial fibrinogen consumption was observed with the two venoms while thrombocytopenia and reduction in the clot amplitude only with B. atrox venom. Moreover, we showed an increase in thrombin generation at H3 with the two venoms, an increase in fibrin generation accompanied with hyperfibrinogenemia at H24 and an increase in inflammatory biomarkers with B. lanceolatus venom. No endothelial damage was found with the two venoms. To conclude, our data support two-sided hemostasis complications in Bothrops envenoming with an initial risk of hemorrhage related to platelet consumption and hypocoagulability followed by an increased risk of thrombosis promoted by the activated inflammatory response and rapid-onset fibrinogen restoration.

Steady electrocorticogram characteristics predict specific stress-induced behavioral phenotypes.

Introduction: Depending on the individual, exposure to an intense stressor may, or may not, lead to a stress-induced pathology. Predicting the physiopathological evolution in an individual is therefore an important challenge, at least for prevention. In this context, we developed an ethological model of simulated predator exposure in rats: we call this the multisensorial stress model (MSS). We hypothesized that: (i) MSS exposure can induce stress-induced phenotypes, and (ii) an electrocorticogram (ECoG) recorded before stress exposure can predict phenotypes observed after stress. Methods: Forty-five Sprague Dawley rats were equipped with ECoG telemetry and divided into two groups. The Stress group (n = 23) was exposed to an MSS that combined synthetic fox feces odor deposited on filter paper, synthetic blood odor, and 22 kHz rodent distress calls; the Sham group (n = 22) was not exposed to any sensorial stimulus. Fifteen days after initial exposure, the two groups were re-exposed to a context that included a filter paper soaked with water as a traumatic object (TO) reminder. During this re-exposure, freezing behavior and avoidance of the filter paper were measured. Results: Three behaviors were observed in the Stress group: 39% developed a fear memory phenotype (freezing, avoidance, and hyperreactivity); 26% developed avoidance and anhedonia; and 35% made a full recovery. We also identified pre-stress ECoG biomarkers that accurately predicted cluster membership. Decreased chronic 24 h frontal Low θ relative power was associated with resilience; increased frontal Low θ relative power was associated with fear memory; and decreased parietal ß2 frequency was associated with the avoidant-anhedonic phenotype. Discussion: These predictive biomarkers open the way to preventive medicine for stress-induced diseases.

Nose-only inhalations of high-dose alumina nanoparticles/hydrogen chloride gas mixtures induce strong pulmonary pro-inflammatory response: a pilot study.

OBJECTIVE: Solid composite propellants combustion, in aerospace and defense fields, can lead to complex aerosols emission containing high concentrations of alumina nanoparticles (Al2O3 NPs) and hydrogen chloride gas (HClg). Exposure to these mixtures by inhalation is thus possible but literature data toward their pulmonary toxicity are missing. To specify hazards resulting from these combustion aerosols, a pilot study was implemented. MATERIALS AND METHODS: Male Wistar rats were nose-only exposed to Al2O3 NPs (primary size 13 nm, 10 g/L suspension leading to 20.0-22.1 mg/m3 aerosol) and/or to HClg aerosols (5 ppm target concentration) following two exposure scenarios (single exposures (SE) or repeated exposures (RE)). Bronchoalveolar lavage fluids (BALF) content and lungs histopathology were analyzed 24 h after exposures. RESULTS: Repeated co-exposures increased total proteins and LDH concentrations in BALF indicating alveolar-capillary barrier permeabilization and cytolysis. Early pulmonary inflammation was induced after RE to Al2O3 NPs ± HClg resulting in PMN, TNF-α, IL-1ß, and GRO/KC increases in BALF. Both exposure scenarios resulted in pulmonary histopathological lesions (vascular congestions, bronchial pre-exfoliations, vascular and interalveolar septum edemas). Lung oxidative damages were observed in situ following SE. CONCLUSION: Observed biological effects are dependent on both aerosol content and exposure scenario. Results showed an important pro-inflammatory effect of Al2O3 NPs/HClg mixtures on the lungs of rat 24 h after exposure. This pilot study raises concerns toward potential long-term pulmonary toxicity of combustion aerosols and highlights the importance for further studies to be led in order to define dose limitations and exposure thresholds for risk management at the work place.

Preconditioning Strategy in Rugby-7s Players: Beneficial or Detrimental?

PURPOSE: Preconditioning strategies are considered as opportunities to optimize performance on competition day. While investigations conducted in rugby players on the effects of a morning preconditioning session already exist, additional work is warranted. The aim of this study was to monitor changes in physical and psychophysiological indicators among international Rugby-7s players following a priming exercise. METHODS: In a randomized crossover-design, fourteen under-18 international Rugby-7s players completed, at 8:00am, a preconditioning session consisting of a warm-up followed by small-sided games, accelerations and 2 x 50-m maximal sprints (Experimental) or no pre-loading session (Control). Following a 2-hour break, the players performed a set of six 30-m sprints and a Rugby-7s match. Recovery-stress state and salivary stress-markers levels were assessed before the preloading session (Pre), immediately after (Post-1), before the testing session (Post-2) and after (Post-3). RESULTS: Experimental-Control differences in performance across a repeated sprint test consisting of six 30-m sprints were very likely trivial (+0.2 ±0.7%, 3/97/1%). During the match, the total distance covered and the frequency of decelerations were possibly lower (small) in Experimental compared to Control. Differences observed in the other parameters were unclear or possibly trivial. At Post-2, the perceived recovery-stress state was improved (small difference) in Experimental compared with Control. No difference in salivary cortisol response was observed while the preconditioning session induced a higher stimulation of salivary testosterone and alpha-amylase. CONCLUSIONS: The players' ability to repeat sprints and physical activity in match-play did not improve but their psychophysiological state was positively affected after the present pre-conditioning session.

Daytime Exposure to Blue-Enriched Light Counters the Effects of Sleep Restriction on Cortisol, Testosterone, Alpha-Amylase and Executive Processes.

Sleep debt is becoming a better acknowledged cause of physiological stress and neurobehavioral deficits with major public-health concerns. We investigated whether exposure to blue light during daytime could be an efficient countermeasure to limit sleep restriction's impact on relevant behavioral (stress, sleepiness, sustained attention, and memory performance) and physiological (saliva cortisol, testosterone, and alpha-amylase) markers. Our semi-ecological, crossover, randomized design included 17 young men that underwent two sleep-restricted nights (3 h each) followed or not by blue light exposure (30-min-long sessions at 100 lux repeated four times throughout the day). Behavioral and physiological measurements were performed in the lab but outside these periods the participants kept following their usual routine. After sleep restriction, morning cortisol and testosterone, and afternoon alpha-amylase levels decreased. In parallel, subjective ratings of stress and sleepiness increased while performance on the sustained attention and memory tasks deteriorated. In contrast, after periods of blue light exposure, all these parameters were largely restored to baseline levels, despite an identical sleep restriction procedure, although this restorative effect was reduced for the memory task. Our findings suggest that even short exposure to blue light could trigger persistent beneficial effects throughout the day and could be potentially efficient in real-life settings.

[Myoglobin: still a useful biomarker in 2017?] / Y a-t-il un intérêt au dosage de la myoglobine en 2017 ?

The clinical biologist plays a role as a consultant for the relevant use of biological examination. Advisory activities of the medical laboratory may help physician in diagnosis or therapeutic algorithm, avoiding redundant ordering or useless tests. In this context, we performed a review of literature about the clinically interest of myoglobin assays. The indications of myoglobin's assays appear fairly limited. It is no longer mentioned in the European guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. In patients with rhabdomyolysis myoglobin is neither a diagnostic nor a prognostic criterion. Its interest in predicting the occurrence of acute renal failure is also discussed. The most recent clinico-biological score (such as the McMahon score) do not integrate it. In this context, we decided to stop performing myoglobin assay.

Immunoglobulin D and cardiac amyloidosis: development and a case illustration.

Amyloidosis results from extra-cellular deposition of proteins which interfere with tissue function. We report the case of a patient with pathological heart involvement which is caused by immunoglobulin D amyloidosis, and review current data on the amyloidois diagnosis and management.

[Disseminated Trichosporon asahii infection]. / Infection invasive à Trichosporon asahii.

The present report describes a case of disseminated Trichosporon asahii infection. Trichosporon species has emerged as opportunistic infectious yeast in immunocompromised patients and is resistant to echinocandins. These antifungal drugs are not recommended for trichosporonosis treatment and yeast species identification be attempted for all clinical isolates, particularly with respect to the choice of antifungal therapy for specific Trichosporon species.