Effective low-dose sirolimus regimen for kaposiform haemangioendothelioma with Kasabach-Merritt phenomenon in young infants

Aims Management of kaposiform haemangioendotheliomas (KHE) with Kasabach-Merritt phenomenon is challenging in young infants who are subjected to developmental pharmacokinetic changes. Sirolimus, sometimes combined with corticosteroids, can be used as an effective treatment of KHE. Simultaneously, toxicities such as interstitial pneumonitis related to the use of sirolimus may be fatal. As infants have a very low CYP3-enzyme expression at birth, which rises during ageing, we hypothesize that a reduced metabolization of sirolimus might lead to high sirolimus serum levels and low dose may be sufficient without the side effects. Methods A case series of 5 infants with kaposiform haemangioendothelioma with Kasabach-Merritt phenomenon was analysed retrospectively. All infants were treated with sirolimus 0.2 mg/m(2) every 24 or 48 hours according to their age. Prednisone was added to the therapy for additional effect in 4 patients. Results In all patients, low dose of sirolimus led to therapeutic sirolimus levels (4-6 ng/mL). All infants (aged 4 days-7 months) had a complete haematological response, without serious adverse events. In all patients, the Kasabach-Merritt phenomenon resolved, the coagulation profile normalized and tumour size reduction was seen. Conclusion Low-dose sirolimus treatment is safe for infants with kaposiform haemangioendothelioma and Kasabach-Merritt phenomenon. It is essential to realize that during the first months of life, metabolism is still developing and enzymes necessary to metabolise drugs like sirolimus still have to mature. To avoid toxic levels, the sirolimus dosage should be based on age and the associated pharmacological developments

Le rumex à feuilles obtuses dans les systèmes herbagers : importance de la problématique, lutte chimique et méthodes alternatives

Parmi les questions relatives à l'entretien des prairies, la lutte contre le rumex est une préoccupation fréquente, du fait de la vigueur et de la capacité d’adaptation considérables de la plante et de la difficulté de la lutte contre cette adventice invasive dans des couverts complexes... Une enquête réalisée en région wallonne auprès d'exploitants agricoles et portant sur leurs pratiques de gestion et d'entretien des prairies montre l’importance de la pression exercée par Rumex obtusifolius L. qui représente un problème pour 40% d'entre eux ; la complémentation et l'épandage de lisier et de fumier de bovins sont corrélés avec la difficulté exprimée par les éleveurs. Une revue complète des traitements chimiques est effectuée selon la nature du couvert et l'âge de la prairie. Diverses méthodes de lutte alternatives sont également présentées (faux semis, type de travail du sol, gestion du pâturage…) ainsi que leur efficacité sur les jeunes plantules et sur les repousses de plantes de rumex

First Report of Wheat Leaf Rust in the Grand Duchy of Luxembourg and the Progress of its Appearance over the 2003–2008 Period

Wheat leaf rust caused by Puccinia triticina Eriks. was identified for the first time in 2000 in the Grand Duchy of Luxembourg on the basis of orange-to-brown, round-to-ovoid, erumpent uredinia (1 to 1.5 mm in diameter) scattered on the upper and lower leaf surfaces and producing orange-brown urediniospores that are subgloboid, approximately 20 μm in diameter, and with up to eight germ pore scattered in thick, echinulate walls. In a second phase, wheat was monitored weekly (starting from Zadoks growth stage 30, pseudo stem erection) during the 2003–2008 cropping seasons for wheat leaf rust. Disease severity (percentage of leaf area with symptoms) was recorded in four, replicated field experiments located in three villages (Diekirch District: Reuler; and Grevenmacher District: Burmerange and Christnach), which are representative of the different agroclimatological zones of Luxembourg. A significant difference in severity was observed between the sites (P < 0.01) and the years (P < 0.05). Over the 6-year period, Burmerange and Reuler consistently showed the highest and lowest disease severity, respectively. In 2003 and 2007, Burmerange (a southern site with the highest average spring temperatures of 13.6 and 14.0°C, respectively) showed the highest disease severity with 66 and 57%, respectively, whereas the lowest severity (<1% for both years) was observed in the north at Reuler (site with the lowest average spring temperatures of 12.0 and 12.4°C, respectively). Christnach, located midway between Reuler and Burmerange, showed an intermediate disease severity with 7% (2003) and 22% (2007). The disease appeared at growth stages 77 (late milk) and 87 (hard dough) in the period 2003–2005, but at an earlier stage (45, boots swollen) for 2006–2008 (P < 0.001). In 2005, low severity was recorded due to a severe drought during May, June, and July. A reason for this earlier appearance of leaf rust occurrences in the two districts may be related to an increase in the average spring temperature (average March to May temperature for Luxembourg was 8.3°C for the 1971–2000 period, 9.5°C for the 2003–2005 period, 9.9°C for the 2006–2008 period, 2007 was exceptional with 11.9°C, P < 0.01). In the past, cereal disease management strategies were oriented toward the control of predominant and yield-reducing diseases such as that caused by Septoria tritici Desm. Because the succession of mild winters and warm springs during the last 5 years allowed the early occurrence and the fast development of wheat leaf rust in the Grand Duchy of Luxembourg, it is advisable to take this disease into account in fungicide application schemes

First Report of Fusarium Head Blight (FHB) on Winter Wheat in the Grand Duchy of Luxembourg

Following a comparatively mild winter (1.9°C above average [2000–2007]), Fusarium head blight (FHB) on winter wheat was observed during the 2007 season in 17 sites representing all three districts of Diekirch, Grevenmacher, and Luxembourg. The cultivars encountered were diverse and included Achat, Akteur, Aron, Bussard, Cubus, Enorm, Exclusiv, Flair, Rosario, Tommi, and Urban. The preceding crops were maize (six sites), rapeseed (three sites), and one site each of pea, triticale, winter barley, and winter wheat. Rainfalls recorded during the flowering period (June 1–23, mean June 12 for GS 65) ranged from 13 to 62 (mean 38) mm. An overall prevalence of FHB (percentage of infected spikes) of 8.9 ± 15.5% (mean ± SD) and a severity (percentage of infected grains per spike) of 21.0 ± 17.8% were recorded. A significant difference in FHB severity was observed between the cantons north and south of Luxembourg City, 13.4 ± 13.1% (range 0.01 to 46.4) and 35.1 ± 18.1% (range 6.2 to 61.9), respectively (Man-Whitney, P = 0.027), indicating the importance to take regional specificities such as topoclimatological aspects into account. Maize as a preceding crop resulted in significant higher prevalence of FHB as opposed to the other crops (5.9 ± 1.6% versus 3.3 ± 2.2%, Man-Whitney, P = 0.022)

The decision to have an abortion from both partners’ perspectives : a dyadic analysis

Objectives: Male partners are often involved in induced abortion although they have no legal rights. It is, however, unknown how women's thoughts and feelings regarding the decision for abortion are associated with the decisional experiences of the involved male partners and vice versa. Methods: Flemish women and their involved male partners (IMP) filled out a questionnaire on abortion motives and feelings of decisiveness in the abortion centre waiting room (N=106 couples). Actor Partner Interdependence Models investigated whether the decisiveness of one partner was associated with a subjective feeling of autonomy (high internal, low external abortion motivation) and decisiveness of the other partner, above and beyond the own feeling of autonomy and personal vulnerabilities for being uncertain. Results: Partner congruence in motivation and decisiveness was substantial (r=0.23 to 0.42), especially for cohabiting partners. The IMPs were less internally motivated for the abortion than the women but both partners reported more internal than external motives, and they both tended to feel certain. In contrast to the women, a higher subjective feeling of autonomy in the IMPs was not associated with feeling more certain. When accounting for partners' living situation, levels of uncertainty were not only associated with personal vulnerabilities for being uncertain, but were also related to the degree of uncertainty and subjective level of autonomy of the other partner. Conclusions: Partners' thoughts and feelings regarding the decision for abortion partially have an interpersonal basis and mostly run parallel despite an inherent gender difference in level and importance of decision autonomy

Fusarioses sur blé d'hiver au Grand-Duché de Luxembourg

peer reviewedAu Grand-Duché de Luxembourg, la campagne 2006-2007 a été caractérisée par un hiver relativement doux et un printemps pluvieux. Ces conditions météorologiques ont permis le développement de nombreuses maladies cryptogamiques sur le blé d’hiver, dont la fusariose. Cette maladie a été suivie sur 17 sites couvrant le G-D de Luxembourg par des mesures de prévalence (pourcentage moyen d’épis visuellement infectés) et de sévérité (pourcentage moyen d’épillets atteints par épi). Des valeurs moyennes de 8,9± +/- 15,5 % pour la prévalence et de 21,0± +/- 17,8 % pour la sévérité ont été enregistrées avec des différences significatives entre les cantons nord et sud pour la sévérité. Plus de 600 souches isolées des 17 sites ont été identifiées suivant des critères morphologiques et l’emploi d’outils moléculaires. 5 espèces semblent associées à la fusariose : Fusarium graminearum (23,5 %), F. culmorum (12,8 %), F. poae (19,4 %) (3 espèces potentiellement productrices de mycotoxines), F. avenaceum (20 %) et Microdochium nivale (18,7 %). Cette étude est la première du genre à avoir été faite au Grand-Duché de Luxembourg.FUSATO

Broadleaved dock in grassland farming systems: importance of the problems raised, chemical control and control by alternative methods

Une enquête réalisée en région wallonne auprès d'exploitants agricoles et portant sur leurs pratiques de gestion et d'entretien des prairies montre l'importance de la pression exercée par rumex obtusifolius L. qui représente un problème pour 40 % d'entre eux; la complémentation et l'épandage de lisier et de fumier de bovins sont corrélés avec la difficulté exprimée par les éleveurs. Une revue complète des traitements chimiques est effectuée selon la nature du couvert et l'âge de la prairie. Diverses méthodes de lutte alternatives sont également présentées (faux semis, type de travail du sol, gestion du pâturage, ...) ainsi que leur efficacité sur les jeunes plantules et sur les repousses de plantes de rumex

General practitioners-community pharmacists pharmacotherapy discussion groups: Analysis of their implementation through a series of case studies

Background: The evolution of primary care practice has led to the implementation of pharmacotherapy discussion groups between general practitioners and community pharmacists (PPPDGs) in some countries. The aim of these groups is to improve drug prescribing practices and strengthen interprofessional relationships. Objective: To gain more insight into factors involved in successful implementation of PPPDGs. Methods: PPPDG implementation in three countries (Belgium, the Netherlands, Switzerland), was analyzed in a series of case studies. A grid describing different evaluation criteria was completed by stakeholders in their respective country. The data collection was followed by a literature review. Results: Various models were used to implement PPPDGs within each country and different dynamics were encountered. PPPDGs lead to positive effects on the quality and cost-effectiveness of drug prescribing and on the collaboration between general practitioners (GPs) and community pharmacists (CPs). Factors involved in implementation were also identified, such as expectations of GPs and CPs, configuration of the implemented model, and the role of CPs in the healthcare organization. Conclusions: This study provides insight into the factors involved in successful implementation of PPPDGs in Belgium, the Netherlands and Switzerland. The findings can be used by healthcare professionals to improve the safety, cost-effectiveness of drug prescriptions and systems in primary care. This study offers a starting point for further research in the field