Whipple's disease diagnosed during biological treatment for joint disease

Objectives Increased susceptibility to infections is among the main safety concerns raised by biological agents. We describe five cases of Whipple\u27s disease diagnosed during treatment with biological agents. Methods We retrospectively identified five cases of Whipple\u27s disease diagnosed between 2003 and 2009 in patients treated with TNFα antagonists in five French hospitals. Results Five patients (four male; mean age: 50.4 years; range: 38–67) underwent biological therapy according to prior diagnoses of rheumatoid arthritis (n = 2), ankylosing spondylitis (n = 2), or spondyloarthropathy (n = 1). Biological therapy failed to control the disease, which responded to appropriate antibiotics for Whipple\u27s disease. Retrospectively, clinical symptoms before biological therapy were consistent with Whipple\u27s disease. All five patients had favorable outcomes (mean follow-up, 29 months [13–71]). Conclusions Biological therapy probably worsened preexisting Whipple\u27s disease, triggering the visceral disorders. Whipple\u27s disease must be ruled out in patients with joint disease, as patients with this spontaneously fatal condition should not receive immunosuppressive agents

A Virtual Testing Approach for Laminated Composites Based on Micromechanics

International audienceThe chapter deals with a crucial question for the design of composite structures: how can one predict the evolution of damage up to and including final fracture? Virtual testing, whose goal is to drastically reduce the huge number of industrial tests involved in current characterization procedures, constitutes one of today’s main industrial challenges. In this work, one revisits our multiscale modeling answer through its practical aspects. Some complements regarding identification, kinking, and crack initiation are also given. Finally, the current capabilities and limits of this approach are discussed, as well as the computational challenges that are inherent to “Virtual Structural Testing.

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369