Acute grade IV toxic hepatitis due to the e-cigarette.

A 46-year-old woman presented at the emergency department because of acute hepatitis with jaundice. After hepatological work-up including liver biopsy, drug induced liver disease (DILI) was suspected. Patient recovered completely within a few months. One year later she presented again with jaundice due to acute hepatitis. Vaping was the only agent that could be identified as causative agent for DILI. After VAPING cessation, the hepatitis resolved completely. Calculated RUCAM score was 10, making the diagnosis of toxic hepatitis very likely. During follow-up liver tests remained normal. This is the first report of severe DILI secondary to the use of e-cigarettes. In future vaping can be included in the differential diagnosis of DILI.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.20 ppm.

We present a new measurement of the positive muon magnetic anomaly, a_{µ}≡(g_{µ}-2)/2, from the Fermilab Muon g-2 Experiment using data collected in 2019 and 2020. We have analyzed more than 4 times the number of positrons from muon decay than in our previous result from 2018 data. The systematic error is reduced by more than a factor of 2 due to better running conditions, a more stable beam, and improved knowledge of the magnetic field weighted by the muon distribution, ω[over ˜]_{p}^{'}, and of the anomalous precession frequency corrected for beam dynamics effects, ω_{a}. From the ratio ω_{a}/ω[over ˜]_{p}^{'}, together with precisely determined external parameters, we determine a_{µ}=116 592 057(25)×10^{-11} (0.21 ppm). Combining this result with our previous result from the 2018 data, we obtain a_{µ}(FNAL)=116 592 055(24)×10^{-11} (0.20 ppm). The new experimental world average is a_{µ}(exp)=116 592 059(22)×10^{-11} (0.19 ppm), which represents a factor of 2 improvement in precision.

Tritium Beta Spectrum Measurement and Neutrino Mass Limit from Cyclotron Radiation Emission Spectroscopy.

The absolute scale of the neutrino mass plays a critical role in physics at every scale, from the subatomic to the cosmological. Measurements of the tritium end-point spectrum have provided the most precise direct limit on the neutrino mass scale. In this Letter, we present advances by Project 8 to the cyclotron radiation emission spectroscopy (CRES) technique culminating in the first frequency-based neutrino mass limit. With only a cm^{3}-scale physical detection volume, a limit of m_{ß}<155 eV/c^{2} (152 eV/c^{2}) is extracted from the background-free measurement of the continuous tritium beta spectrum in a Bayesian (frequentist) analysis. Using ^{83m}Kr calibration data, a resolution of 1.66±0.19 eV (FWHM) is measured, the detector response model is validated, and the efficiency is characterized over the multi-keV tritium analysis window. These measurements establish the potential of CRES for a high-sensitivity next-generation direct neutrino mass experiment featuring low background and high resolution.

A single-centre analysis of post-colonoscopy colorectal cancer.

PATIENTS AND METHODS: A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. RESULTS: 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. CONCLUSIONS: The data of our centre are in line with the data of the literature from which can be concluded that most postcolonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

Beta Decay of Molecular Tritium.

The beta decay of tritium in the form of molecular T_{2} is the basis of sensitive experiments to measure neutrino mass. The final-state electronic, vibrational, and rotational excitations modify the beta spectrum significantly and are obtained from theory. We report measurements of the branching ratios to specific ionization states for the isotopolog HT. Two earlier, concordant measurements gave branching ratios of HT to the bound HHe^{+} ion of 89.5% and 93.2%, in sharp disagreement with the theoretical prediction of 55%-57%, raising concerns about the theory's reliability in neutrino mass experiments. Our result, 56.5(6)%, is compatible with the theoretical expectation and disagrees strongly with the previous measurements.

On the relative stability of self-assembled metallosupramolecular subphthalocyanine capsules determined by ESI-Q-TOF tandem mass spectrometry.

A comparative study of the relative stability of subphthalocyanine metallosupramolecular capsules bearing different metals and ligands has been carried out by electrospray ionization quadrupole time-of-flight tandem mass spectrometry experiments. The results highlight the trends in the strength of metal-nitrogen bonds as well as the 'trans effect' of certain ligands.

Evidence-based recommendations on automated external defibrillator training for children and young people in Flanders-Belgium.

OBJECTIVE: The aim of the study was to identify the most relevant literature on skills, attitude and behaviour of children and young people towards the use of an automated external defibrillator (AED) and then develop recommendations according to the principles of evidence-based practice. These recommendations were to serve as a basis for educational materials which would ensure that the implementation of AED-training within schools and youth organisations would be a simple process. METHODS: A systematic literature search was performed using a specific research question: "Are children of different ages able/willing to use an AED after a training compared to another/no training?". A guideline development panel meeting was organised to formulate practice guidelines. The panel consisted of experts from different fields (medicine, education and psychology) and representatives of the end users (teachers and youth leaders). RESULTS: The systematic literature search identified five studies concerning AED skills by children and young people, and two studies concerning the attitudes and behaviour of children and young people towards the use of an AED. The guideline development panel carefully examined the available scientific evidence, took into consideration the skills and attitudes of children and young people, including the psychological consequences of managing a potentially life-saving situation and formulated evidence-based recommendations and good practice points. CONCLUSION: Based on these recommendations, an education programme and new educational materials have been developed by the Belgian Red Cross-Flanders. In this way school staff and youth leaders are properly supported to teach first aid techniques to children and young people (6-18 years).

High hepatitis C virus prevalence and incidence among Canadian intravenous drug users.

We used data and leftover samples collected through the SurvUDI network to describe the epidemiology of hepatitis C virus (HCV) infection among injection drug users (IDUs) in Eastern Central Canada. Among the 1380 selected IDUs, having participated twice or more between 1997 and 2003, the overall HCV prevalence rate was 60.4% (95% confidence interval [CI]: 57.7-63.0%). Among the 543 initially uninfected participants, the HCV incidence rate was 27.1 per 100 person-years (95% CI: 23.4-30.9 per 100 person-years). Independent predictors of seroconversion, identified among 359 participants, were age, injecting for a year or less, injecting with a syringe previously used by someone else, injecting most often cocaine, engaging in prostitution, and being recruited in a major urban centre. The HCV epidemic severely affects IDUs in this area. Actions to prevent HCV transmission, such as distribution of sterile injection equipment, have to be reinforced. Special efforts have to be targeted towards starting IDUs.

Supernormal left ventricular diastolic function in triathletes.

We studied the structural and functional heart adaptations of 52 male triathletes compared with those of 22 active, nonathletic men, by 2-dimensional Doppler echocardiography. Left ventricular diastolic function was evaluated by recording transmitral flow velocities. To exclude the influences of preload, left atrial pressure, and aortic pressure, left ventricular diastolic function was also evaluated by pulsed Doppler tissue imaging. Significant differences in cardiac structure and function were observed between the 2 groups. In the triathletes, the left ventricular diastolic function was completely normal, despite signs of mixed eccentric and concentric left ventricular hypertrophy, and this function was better than that in the control group. We measured 2 aspects of the late passive diastolic filling period in the triathletes: ASEAC value (the amplitude of excursion of the interventricular septal endocardium at the end of left ventricular diastole just after atrial contraction); and the time between onset of the P wave on the electrocardiographic tracing and onset of systolic septal movement on M-mode echocardiography. Pulsed Doppler tissue imaging confirmed these results. The E/A ratios (peak early left ventricular diastolic motion velocity divided by the peak atrial systolic motion velocity), measured by pulsed Doppler tissue imaging, yielded even more evidence for supernormal left ventricular diastolic function in the triathletes. Left ventricular relaxation and filling properties were measured along the longitudinal and transverse axes by pulsed Doppler tissue imaging, which was useful for evaluating left ventricular diastolic function. We determined that triathletes may develop supernormal left ventricular diastolic function with increased diastolic reserves.

Importance of determining the percentage body fat in endurance-trained athletes.

A triathlete has to complete a hard endurance effort in aerobic circumstances. This requires important cardiovascular, haemodynamic and metabolic adaptations which alter the percentage body fat. This study included 52 triathletes and 22 control persons. The anthropometric data of the two groups were similar. All the subjects underwent the same extensive non-invasive cardiac exploration with two-dimensional cardiac echo-doppler examination. Maximal incremental exercise tests with determination of lactate and the ventilatory threshold were done on bicycle and on treadmill. Three different methods determined the percentage of body fat: 4 and 12 skin fold method, bioelectrical impedance analysis and dual energy X-ray absorptionmetry. The results showed important structural and functional heart changes in the triathletes. These changes caused distinct heamodynamic adaptations so that the maximal performing capacity and the aerobic capacity could be forced up largely. The haemodynamic adaptations were connected with changes in the percentage body fat in triathletes. The determination of the 12 skin fold measurements enabled us to distinguish the triathletes with better competition results from the inferior triathletes. It is concluded that the method of 12 skin fold measurements gives the most reliable results and requires only a limited instrumentarium. Moreover, this examination can be performed correctly and easily in all circumstances.

[Drugs, Poverty and HIV: results regarding a provincial needle exchange program in Point de Repères, Quebec]. / Drogues, pauvreté et VIH: données en provenance du programme d'échange de seringues Point de Repères, Québec.

In this study (n = 200), the characteristics of IDUs participating in a provincial needle exchange program (NEP) for more than 2 years (> 2 years) were compared with those of IDUs having participated for less than 2 years (< or = 2 years). Compared to the < or = 2 years, the > 2 years were more often recipients of welfare (RC: 4.7), especially among the HIV-positive (RC: 62.0); tried quitting drugs more frequently (RC: 3.8); more often recommended the NEP to other IDUs (RC: 3.1); and more often requested being given shelter and longer opening hours (RC: 3.6). These results highlight the urgent need to improve and develop transitional and support services for the > 2 years. Preventive interventions that would reach out to the < or = 2 years where they live should also be implemented in close collaboration with organizations involved in mental health and drug use prevention.

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Changes in mortality of acute myocardial infarction as a function of a changing treatment during the last two decades.

Forty years ago, after the establishment of coronary care units, a significant decrease in mortality of acute myocardial infarction was noted. Twenty years ago, the break-through of thrombolysis realized once again a significant decrease in mortality. In this study we compare, in a rather small community hospital, the mortality and safety of thrombolytic therapy in acute myocardial infarction with a more conventional, conservative medical therapy. We examined all cases of acute myocardial infarction between 1978 up to 1998 inclusive, concerning treatment and mortality rate after a six month period. To be included in the study, acute myocardial infarction had to fulfill particular inclusion criteria. A total of 1863 cases of acute myocardial infarction were included. The mortality rate of patients with acute myocardial infarction treated with thrombolytic agents was strikingly lower and statistically very significantly different (p < 0.001) in comparison with the mortality rate of patients treated with heparin or coumarine derivatives. The mortality rate dropped from 10.57% in the coumarine group and from 14.95% in the heparin group to 5.41% in the alteplase group, to 4.95% in the anistreplase group and 4.00% in the streptokinase subgroup. The complications directly connected to the treatment did not seem to be different between the five groups, and they were also not more frequent by using thrombolytic agents. In the last 20 years, better preventive measures (life habits, diet, medication) and trials to better control the risk factors have not influenced greatly the average amount of cholesterol in patients with an acute myocardial infarction. Also the percentage of patients with high blood pressure has hardly decreased over the last 20 years. The mortality associated with acute myocardial infarction has decreased significantly with the use of thrombolytics. In most cases, thrombolytics are administered routinely and safely. In this way, they are the first choice therapy for myocardial infarction in smaller hospitals. To obtain excellent coronary patency, thrombolytic agents with a long half-life and with PAI-1 resistance are required in the future. The current measures and medical therapies seem to be insufficient to control the risk factors for coronary atherosclerosis.

Physiological or pseudophysiological ECG changes in endurance-trained athletes.

"Sudden cardiac death" in seemingly healthy, active, and asymptomatic people has always been a tragic fact and is now occurring more frequently. Thus, the preventive detection of "subjects at risk" becomes a priority. A traditional resting electrocardiogram can sometimes give useful indications. Fifty-two competitive triathletes were compared with 22 control persons with similar anthropometric parameters. All subjects underwent the same noninvasive cardiac exploration with electrocardiography, bidimensional echo-Doppler examination, and maximal spiroergometric exercise tests, on a stationary bicycle as well as on a treadmill. In the triathletes we noted manifest signs of eccentric as well as concentric left ventricular hypertrophy with arguments for a supernormal diastolic left ventricular function, with important hemodynamic adjustments and with consequences on the resting electrocardiogram. We described "ten commandments" in evaluating the resting electrocardiogram of healthy competitive athletes. We suspect that the occurrence of ventricular premature beats at peak load of a maximal exercise could be the first expression of a pathological cardiac adaptation to sports activities. The resting electrocardiogram can show interesting details in detecting the "subjects at risk" for problems such as possible lethal arrhythmias and "sudden cardiac death." The analysis of the four subgroups of triathletes compels us to feel dubious about the "athletic heart syndrome" as a physiological entity. In several cases the "athletic heart" is possibly a transitional situation to a pathological hypertrophic and dilated cardiomyopathy.

Ventricular premature beats in triathletes: still a physiological phenomenon?

UNLABELLED: Sudden death is a tragic fact, unexpectedly arising in all age groups. Ventricular arrhythmias are the main cause. At the end of a maximal exercise test more ventricular premature beats were noted in a group of well trained triathletes compared with a similar control group. The etiology is multifactorial. When these ventricular premature beats are associated with specific structural and functional heart adaptations, echocardiographically and electrocardiographically well-documented, then those 'banal' ventricular premature beats cannot longer be considered as a physiological phenomenon. In these circumstances the involved subject is a candidate for dangerous arrhythmias and 'sudden cardiac death'. PURPOSE: The principal cause of 'Sudden cardiac death' is ventricular arrhythmias. We explore the incidence of ventricular premature beats (VPB) in triathletes, who engage in enforced endurance sports. METHODS: Fifty-two triathletes were compared with twenty-two control subjects with comparable anthropometric parameters in function of structural and functional cardiac adaptations. Maximal exercise tests were conducted on a stationary bicycle and a treadmill. During the last two minutes of each test, the VPB were registered. RESULTS: Statistically significant differences emerged in the cardiac structure and function between the triathletes and the controls. There were signs of cardiac hypertrophy and arguments for a supernormally diastolic left ventricular function in the triathletes. The performance capacity was also significantly higher in the triathletes. The maximal heart rate was significantly higher in the control group. The number of VPB was significantly higher in the triathletes. The increased risk of VPB in the triathlon group is caused by several factors: the degree of cardiac hypertrophy, the increased diastolic reserve, the duration of the exercise, the existence of an aortic insufficiency jet and some specific electrocardiographic findings. CONCLUSIONS: The triathlete has an increased risk of VPB during maximal efforts. We doubt the traditionally accepted view of the physiological nature of those VPB and suspect that the limit of physiological cardiac adaptations to sport efforts is exceeded with the appearance of VPB. The triathlete with VPB and with specific electrocardiographic and echocardiographic findings is a candidate for 'sudden cardiac death'.

Structural heart adaptations in triathletes.

OBJECTIVE: To perform a triathlon in aerobic conditions, a variety of cardiovascular, haemodynamic and metabolic adaptations are required. The heart is the central concern and also the most important limiting factor. In this study we investigate the structural and functional heart adaptations of a group of triathletes. METHODS AND RESULTS: A group of 52 male triathletes was divided into 4 subgroups in function of their athletic results and compared with a control group of 22 healthy, very active but no athletic men. The groups had comparable anthropometric and general physical characteristics. Very significant differences in cardiac structure and cardiac function were observed between the groups. In the triathletes, we registered distinct signs of significantly mixed eccentric and concentric hypertrophy. Unlike the findings in a pathological left ventricular hypertrophy, the diastolic left ventricular function in triathletes was completely normal and even better than in the control group. The late passive diastolic filling period of the triathlete, in particular, seemed to have specific characteristics. The comparison between the subgroups of triathletes shows us that genetic factors probably play an important role in the cardiac adaptations in triathletes. CONCLUSIONS: In our opinion the "athletic heart" in triathletes is not a specific "physiological entity" but is a transitional phase to a dilated hypertrophic cardiomyopathy. Our study yields some arguments for the following proposition: "People are born as elite athletes, with specific characteristics of the left ventricle and with a specifically supernormal diastolic left ventricular function."

Immunospecific targeting of liposomes to erythrocytes.

Immunoliposomes were made by covalently linking Fab' fragments (from rabbit antimouse erythrocyte IgG) to reverse-phase evaporation vesicles (REV) via maleimido-4-(p-phenylbutyrate) phosphatidylethanolamine (MPB-PE) as anchor molecule. These immunoliposomes were characterized in terms of size, charge, stability and antigen binding capacity. The effect of the liposomal Fab' density on the interaction with the target cell was studied. Two isolation methods were tested to separate free Fab' from liposomally bound Fab'. The necessity of deactivation of remaining reactive sites with dithiothreitol preincubation to increase the specificity of immunoliposome target cell interactions was demonstrated.