Starvation ketoacidosis in pregnancy presenting as euglycaemic, high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

Starvation ketoacidosis in pregnancy presenting as euglycaemic high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

How to measure sedentary behavior at work?

Background: Prolonged sedentary behavior (SB) is associated with increased risk for chronic conditions. A growing number of the workforce is employed in office setting with high occupational exposure to SB. There is a new focus in assessing, understanding and reducing SB in the workplace. There are many subjective (questionnaires) and objective methods (monitoring with wearable devices) available to determine SB. Therefore, we aimed to provide a global understanding on methods currently used for SB assessment at work.Methods: We carried out a systematic review on methods to measure SB at work. Pubmed, Cochrane, Embase, and Web of Science were searched for peer-reviewed English-language articles published between 1st January 2000 and 17th March 2019.Results: We included 154 articles: 89 were cross-sectional and 65 were longitudinal studies, for a total of 474,091 participants. SB was assessed by self-reported questionnaires in 91 studies, by wearables devices in also 91 studies, and simultaneously by a questionnaire and wearables devices in 30 studies. Among the 91 studies using wearable devices, 73 studies used only one device, 15 studies used several devices, and three studies used complex physiological systems. Studies exploring SB on a large sample used significantly more only questionnaires and/or one wearable device.Conclusions: Available questionnaires are the most accessible method for studies on large population with a limited budget. For smaller groups, SB at work can be objectively measured with wearable devices (accelerometers, heart-rate monitors, pressure meters, goniometers, electromyography meters, gas-meters) and the results can be associated and compared with a subjective measure (questionnaire). The number of devices worn can increase the accuracy but make the analysis more complex and time consuming

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Electrochemical grafting by reduction of 4-aminoethylbenzenediazonium salt: Application to the immobilization of (bio)molecules

International audienceWe propose in this study a simple and rapid way to produce stable amino-derivatized conductive surfaces for the subsequent immobilization of (bio)molecules. This was achieved through the use of (4-aminoethyl)benzenediazonium salt (AEBD), which was immobilized on glassy carbon and gold electrodes by its electrochemical reduction. The presence of terminal grafted amino functions was evidenced with XPS by analyzing N1s core level. Besides this conventional surface characterisation, an electrochemical strategy is proposed here to evidence the presence of immobilized amines, in which the chemical reactivity of amines towards 2,4,6-trinitrobenzenesulfonic acid (TNBS) is used. Surface-bound TNBS served as an electrochemical marker and was detected by cyclic voltammetry. Additionally, pre-modified gold electrodes with amino functions can be derivatized with biomolecules such as glutathione (GSH). Glutathione attachment was evidenced by studying the electrochemical behaviour of ferri/ferrocyanide redox before and after its immobilization. The functionalized electrodes were then used for the detection of copper ions in neutral aqueous solutions

La téléxérographie du crâne : étude clinique et radiologique

Les auteurs démontrent, sur 70 clichés comparatifs, la supériorité de la téléxérographie pour la céphalométrie orthodontique ou chirurgicale. Le squelette et les tissus mous sont toujours également lisibles sur le même cliché dont la réalisation technique est simple. L'irradiation nécessaire a été mesurée. Elle est actuellement un peu plus élevée en xérographie, mais devrait être inférieure à l'avenir

Large-scale, drift-free SLAM using highly robustified building model constraints

Conference of 2017 IEEE/RSJ International Conference on Intelligent Robots and Systems, IROS 2017 ; Conference Date: 24 September 2017 Through 28 September 2017; Conference Code:133565International audienceConstrained key-frame based local bundle adjustment is at the core of many recent systems that address the problem of large-scale, georeferenced SLAM based on a monocular camera and on data from inexpensive sensors and/or databases. The majority of these methods, however, impose constraints that result from proprioceptive sensors (e.g. IMUs, GPS, Odometry) while ignoring the possibility of explicitly constraining the structure (e.g. point cloud) resulting from the reconstruction process. Moreover, research on on-line interactions between SLAM and deep learning methods remains scarce, and as a result, few SLAM systems take advantage of deep architectures. We explore both these areas in this work: we use a fast deep neural network to infer semantic and structural information about the environment, and using a Bayesian framework, inject the results into a bundle adjustment process that constrains the 3d point cloud to texture-less 3d building models

Increased heart rate after exercise facilitates the processing of fearful but not disgusted faces

Abstract Embodied theories of emotion assume that emotional processing is grounded in bodily and affective processes. Accordingly, the perception of an emotion re-enacts congruent sensory and affective states; and conversely, bodily states congruent with a specific emotion facilitate emotional processing. This study tests whether the ability to process facial expressions (faces having a neutral expression, expressing fear, or disgust) can be influenced by making the participants’ body state congruent with the expressed emotion (e.g., high heart rate in the case of faces expressing fear). We designed a task requiring participants to categorize pictures of male and female faces that either had a neutral expression (neutral), or expressed emotions whose linkage with high heart rate is strong (fear) or significantly weaker or absent (disgust). Critically, participants were tested in two conditions: with experimentally induced high heart rate (Exercise) and with normal heart rate (Normal). Participants processed fearful faces (but not disgusted or neutral faces) faster when they were in the Exercise condition than in the Normal condition. These results support the idea that an emotionally congruent body state facilitates the automatic processing of emotionally-charged stimuli and this effect is emotion-specific rather than due to generic factors such as arousal