Dynamic Nuclear Polarization by Thermal Mixing Under Partial Saturation

We describe a low-temperature thermodynamic model for dynamic nuclear polarization (DNP) via continuous-wave partial saturation of electron spin resonance (ESR) lines that are both homogeneously and inhomogeneously broadened. It is a variant of a reasoning proposed by Borghini, which in turn used Redfield's thermodynamic treatment of saturation. Our variant is furthermore based on Provotorov's insight that under partial saturation of a coupled-spin system two distinct spin temperatures should appear in a thermodynamical theory. We apply our model to DNP results obtained at a temperature of 1.2K and in magnetic fields of 3.35 and 5T on 1-13C labeled sodium acetate dissolved in a frozen D2O/ethanol-d6 solution doped with the free radical TEMP

A surface registration approach for video-based analysis of intraoperative brain surface deformations.

Anatomical intra operative deformation is a major limitation of accuracy in image guided neurosurgery. Approaches to quantify these deforamations based on 3D reconstruction of surfaces have been introduced. For accurate quantification of surface deformation, a robust surface registration method is required. In this paper, we propose a new surface registration for video-based analysis of intraoperative brain deformations. This registration method includes three terms: the first term is related to image intensities, the second to Euclidean distance and the third to anatomical landmarks continuously tracked in 2D video. This new surface registration method can be used with any cortical surface textured point cloud computed by stereoscopic or laser range approaches. We have shown the global method, including textured point cloud reconstruction, had a precision within 2 millimeters, which is within the usual rigid registration error of the neuronavigation system before deformations

Dynamic Nuclear Polarization by Thermal Mixing Under Partial Saturation

We describe a low-temperature thermodynamic model for dynamic nuclear polarization (DNP) via continuous-wave partial saturation of electron spin resonance (ESR) lines that are both homogeneously and inhomogeneously broadened. It is a variant of a reasoning proposed by Borghini, which in turn used Redfield's thermodynamic treatment of saturation. Our variant is furthermore based on Provotorov's insight that under partial saturation of a coupled-spin system two distinct spin temperatures should appear in a thermodynamical theory. We apply our model to DNP results obtained at a temperature of 1.2 K and in magnetic fields of 3.35 and 5 T on 1-C-13 labeled sodium acetate dissolved in a frozen D2O/ethanol-d(6) solution doped with the free radical TEMPO

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Rare causes of hypoglycemia in adults

International audienceHypoglycemia is defined by a low blood glucose level associated to clinical symptoms. Hypoglycemia may be related to treatment of diabetes, but also to drugs, alcohol, critical illness, cortisol insufficiency including hypopituitarism, insulinoma, bariatric or gastric surgery, pancreas transplantation or glucagon deficiency, or may be surreptitious. Some hypoglycemic episodes remain unexplained, and genetic, paraneoplastic and immune causes should be considered. Genetic causes may be related to endogenous hyperinsulinism and to inborn errors of metabolism (IEM). Endogenous hyperinsulinism is related to monogenic congenital hyperinsulinism, and especially to mutations of the glucokinase-activating gene or of insulin receptors, both characterised by postprandial hypoglycemia with major hyperinsulinism. In adulthood, IEM-related hypoglycemia can persist in a previously diagnosed childhood disease or may be a presenting sign. It is suggested by systemic involvement (rhabdomyolysis after fasting or exercising, heart disease, hepatomegaly), sometimes associated to a family history of hypoglycemia. The timing of hypoglycemic episodes with respect to the last meal also helps to orientate diagnosis. Fasting hypoglycemia may be related to type 0, I or III glycogen synthesis disorder, fatty acid oxidation or gluconeogenesis disorder. Postprandial hypoglycemia may be related to inherited fructose intolerance. Exercise-induced hyperinsulinism is mainly related to activating mutation of the SLC16A1 gene. Besides exceptional ectopic insulin secretion, paraneoplastic causes involve NICTH (Non-Islet-Cell Tumour Hypoglycemia), caused by Big-IGF2 secretion by a large tumour, with low blood levels of insulin, C-peptide and IGF1. Autoimmune causes involve antibodies against insulin (HIRATA syndrome), especially in case of Graves' disease, or against the insulin receptor. Medical history, timing, and insulin level orientate the diagnosis

A surface registration approach for video-based analysis of intraoperative brain surface deformations.

Anatomical intra operative deformation is a major limitation of accuracy in image guided neurosurgery. Approaches to quantify these deforamations based on 3D reconstruction of surfaces have been introduced. For accurate quantification of surface deformation, a robust surface registration method is required. In this paper, we propose a new surface registration for video-based analysis of intraoperative brain deformations. This registration method includes three terms: the first term is related to image intensities, the second to Euclidean distance and the third to anatomical landmarks continuously tracked in 2D video. This new surface registration method can be used with any cortical surface textured point cloud computed by stereoscopic or laser range approaches. We have shown the global method, including textured point cloud reconstruction, had a precision within 2 millimeters, which is within the usual rigid registration error of the neuronavigation system before deformations

A surface registration approach for video-based analysis of intraoperative brain surface deformations.

Anatomical intra operative deformation is a major limitation of accuracy in image guided neurosurgery. Approaches to quantify these deforamations based on 3D reconstruction of surfaces have been introduced. For accurate quantification of surface deformation, a robust surface registration method is required. In this paper, we propose a new surface registration for video-based analysis of intraoperative brain deformations. This registration method includes three terms: the first term is related to image intensities, the second to Euclidean distance and the third to anatomical landmarks continuously tracked in 2D video. This new surface registration method can be used with any cortical surface textured point cloud computed by stereoscopic or laser range approaches. We have shown the global method, including textured point cloud reconstruction, had a precision within 2 millimeters, which is within the usual rigid registration error of the neuronavigation system before deformations