37 research outputs found
Пути инновационного развития Автономной Республики Крым
Целью работы является изучение состояния и перспектив дальнейшего развития инновационной активности в Автономной Республике Крым
Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series.
peer reviewed[en] BACKGROUND: Recent alerts have highlighted an increase in group A streptococcal (GAS) infections since 2022 in Europe and the United States. Streptococcus pyogenes can cause limited skin or mucosal disease, but can also present as severe invasive disease necessitating critical care. We performed a multicenter retrospective study of patients with GAS infections recently admitted to Belgian intensive care units (ICUs) since January 2022. We describe patient characteristics and investigate the molecular epidemiology of the S. pyogenes strains involved.
RESULTS: Between January 2022 and May 2023, a total of 86 cases (56 adults, 30 children) with GAS disease were admitted to critical care in the university hospitals of Leuven, Antwerp and Liège. We noted a strikingly high incidence of severe community-acquired pneumonia (sCAP) (45% of adults, 77% of children) complicated with empyema in 45% and 83% of adult and pediatric cases, respectively. Two-thirds of patients with S. pyogenes pneumonia had viral co-infection, with influenza (13 adults, 5 children) predominating. Other disease presentations included necrotizing fasciitis (23% of adults), other severe skin/soft tissue infections (16% of adults, 13% of children) and ear/nose/throat infections (13% of adults, 13% of children). Cardiogenic shock was frequent (36% of adults, 20% of children). Fifty-six patients (65%) had toxic shock syndrome. Organ support requirements were high and included invasive mechanical ventilation (77% of adults, 50% of children), renal replacement therapy (29% of adults, 3% of children) and extracorporeal membrane oxygenation (20% of adults, 7% of children). Mortality was 21% in adults and 3% in children. Genomic analysis of S. pyogenes strains from 55 out of 86 patients showed a predominance of emm1 strains (73%), with a replacement of the M1global lineage by the toxigenic M1UK lineage (83% of emm1 strains were M1UK).
CONCLUSIONS: The recent rise of severe GAS infections (2022-23) is associated with introduction of the M1UK lineage in Belgium, but other factors may be at play-including intense circulation of respiratory viruses and potentially an immune debt after the COVID pandemic. Importantly, critical care physicians should include S. pyogenes as causative pathogen in the differential diagnosis of sCAP
PDRs4All IV. An embarrassment of riches: Aromatic infrared bands in the Orion Bar
(Abridged) Mid-infrared observations of photodissociation regions (PDRs) are
dominated by strong emission features called aromatic infrared bands (AIBs).
The most prominent AIBs are found at 3.3, 6.2, 7.7, 8.6, and 11.2 m. The
most sensitive, highest-resolution infrared spectral imaging data ever taken of
the prototypical PDR, the Orion Bar, have been captured by JWST. We provide an
inventory of the AIBs found in the Orion Bar, along with mid-IR template
spectra from five distinct regions in the Bar: the molecular PDR, the atomic
PDR, and the HII region. We use JWST NIRSpec IFU and MIRI MRS observations of
the Orion Bar from the JWST Early Release Science Program, PDRs4All (ID: 1288).
We extract five template spectra to represent the morphology and environment of
the Orion Bar PDR. The superb sensitivity and the spectral and spatial
resolution of these JWST observations reveal many details of the AIB emission
and enable an improved characterization of their detailed profile shapes and
sub-components. While the spectra are dominated by the well-known AIBs at 3.3,
6.2, 7.7, 8.6, 11.2, and 12.7 m, a wealth of weaker features and
sub-components are present. We report trends in the widths and relative
strengths of AIBs across the five template spectra. These trends yield valuable
insight into the photochemical evolution of PAHs, such as the evolution
responsible for the shift of 11.2 m AIB emission from class B in
the molecular PDR to class A in the PDR surface layers. This
photochemical evolution is driven by the increased importance of FUV processing
in the PDR surface layers, resulting in a "weeding out" of the weakest links of
the PAH family in these layers. For now, these JWST observations are consistent
with a model in which the underlying PAH family is composed of a few species:
the so-called 'grandPAHs'.Comment: 25 pages, 10 figures, to appear in A&
PDRs4All II: JWST's NIR and MIR imaging view of the Orion Nebula
The JWST has captured the most detailed and sharpest infrared images ever
taken of the inner region of the Orion Nebula, the nearest massive star
formation region, and a prototypical highly irradiated dense photo-dissociation
region (PDR). We investigate the fundamental interaction of far-ultraviolet
photons with molecular clouds. The transitions across the ionization front
(IF), dissociation front (DF), and the molecular cloud are studied at
high-angular resolution. These transitions are relevant to understanding the
effects of radiative feedback from massive stars and the dominant physical and
chemical processes that lead to the IR emission that JWST will detect in many
Galactic and extragalactic environments. Due to the proximity of the Orion
Nebula and the unprecedented angular resolution of JWST, these data reveal that
the molecular cloud borders are hyper structured at small angular scales of
0.1-1" (0.0002-0.002 pc or 40-400 au at 414 pc). A diverse set of features are
observed such as ridges, waves, globules and photoevaporated protoplanetary
disks. At the PDR atomic to molecular transition, several bright features are
detected that are associated with the highly irradiated surroundings of the
dense molecular condensations and embedded young star. Toward the Orion Bar
PDR, a highly sculpted interface is detected with sharp edges and density
increases near the IF and DF. This was predicted by previous modeling studies,
but the fronts were unresolved in most tracers. A complex, structured, and
folded DF surface was traced by the H2 lines. This dataset was used to revisit
the commonly adopted 2D PDR structure of the Orion Bar. JWST provides us with a
complete view of the PDR, all the way from the PDR edge to the substructured
dense region, and this allowed us to determine, in detail, where the emission
of the atomic and molecular lines, aromatic bands, and dust originate
PDRs4All III: JWST's NIR spectroscopic view of the Orion Bar
(Abridged) We investigate the impact of radiative feedback from massive stars
on their natal cloud and focus on the transition from the HII region to the
atomic PDR (crossing the ionisation front (IF)), and the subsequent transition
to the molecular PDR (crossing the dissociation front (DF)). We use
high-resolution near-IR integral field spectroscopic data from NIRSpec on JWST
to observe the Orion Bar PDR as part of the PDRs4All JWST Early Release Science
Program. The NIRSpec data reveal a forest of lines including, but not limited
to, HeI, HI, and CI recombination lines, ionic lines, OI and NI fluorescence
lines, Aromatic Infrared Bands (AIBs including aromatic CH, aliphatic CH, and
their CD counterparts), CO2 ice, pure rotational and ro-vibrational lines from
H2, and ro-vibrational lines HD, CO, and CH+, most of them detected for the
first time towards a PDR. Their spatial distribution resolves the H and He
ionisation structure in the Huygens region, gives insight into the geometry of
the Bar, and confirms the large-scale stratification of PDRs. We observe
numerous smaller scale structures whose typical size decreases with distance
from Ori C and IR lines from CI, if solely arising from radiative recombination
and cascade, reveal very high gas temperatures consistent with the hot
irradiated surface of small-scale dense clumps deep inside the PDR. The H2
lines reveal multiple, prominent filaments which exhibit different
characteristics. This leaves the impression of a "terraced" transition from the
predominantly atomic surface region to the CO-rich molecular zone deeper in.
This study showcases the discovery space created by JWST to further our
understanding of the impact radiation from young stars has on their natal
molecular cloud and proto-planetary disk, which touches on star- and planet
formation as well as galaxy evolution.Comment: 52 pages, 30 figures, submitted to A&
Exposure to cough aerosols and development of pulmonary COVID-19
Contains fulltext :
226221.pdf (Publisher’s version ) (Closed access)
Contains fulltext :
226221pre.pdf (Author’s version preprint ) (Open Access
Exposure to cough aerosols and development of pulmonary COVID-19
Contains fulltext :
226221.pdf (Publisher’s version ) (Closed access)
Contains fulltext :
226221pre.pdf (Author’s version preprint ) (Open Access
Respiratory support in the absence of abdominal muscles : a case study of ventilatory management in prune belly syndrome
Japanese encephalitis in a young traveler from a short-term holiday in Khao Lak, Thailand
Traiter ou ne pas traiter?
La décision de traiter ou non repose sur le risque fracturaired'un patient, son adhésion à la prise en charge, l'efficacité dutraitement et son profil d'effets indésirables, et sur le remboursementde ce dernier. Différents algorithmes, dont l'outil FRAX,permettent d'évaluer le risque fracturaire. Ce dernier outil aquelques limites: absence de quantification du type de fracturesantérieures, mauvaise appréciation du risque lié à une corticothérapiesystémique active, absence de validation prospective.Le seuil thérapeutique peut être fixe indépendant de l'âgeou varier avec l'âge. Les analyses coût-efficacité montrent quepour un même profil de risque, plus la personne est âgée, plusgrand est le bénéfice économique. Le jugement clinique peutnous guider dans certaines situations. La fracture non traumatique,l'âge avancé, la corticothérapie, un T-score abaissé sontles principaux facteurs de risque utilisés en pratique. Dans l'approchediagnostique, la recherche de la fracture vertébrale sousjacenteest impérative, idéalement par IVA. Les quelques exemplesci-dessous montrent les limites des algorithmes et dujugement clinique.Sans facteur de risque pour l'ostéoporose, mais avec un T-scoreà -3.2 DS, à quel âge va-t-on débuter un traitement chez cettefemme ? Avant ou après 60 ans ? Certaines situations cliniquessemblent claires et posent l'indication à traiter: la fracture de lahanche, la fracture vertébrale spontanée, la corticothérapie aulong cours. Mais si pour ces trois situations la densitométrieosseuse donne un T-score à -0.5 DS, ou si le patient a 35 ans,est-ce que chaque clinicien sera d'accord de traiter ? On saitpar exemple que le risque fracturaire sous corticothérapie aulong cours semble faible chez la femme préménopausée et chezl'homme avant 50 ans. Que faire après une fracture du poignetà 50 ans : ne pas traiter si le T-score est à -1.5 DS et traiter si leT-score est à -3 DS ? L'antécédent de fracture du poignet n'estpas un facteur de risque aussi fort de la fracture subséquenteque la hanche, la vertèbre ou l'humérus. Et chez cette femme de80 ans ayant eu une fracture de côte sur un effort de toux, avecun T-score à -2.5 DS ? Ou cette autre femme de 83 ans, sansfacteur de risque particulier pour l'ostéoporose mais avec unT-score à -3.1 DS ? Ces deux dernières femmes bénéficient d'untraitement en terme économique et le praticien respecte les indicationsau remboursement. Mais certains modèles préconisentde ne pas traiter les personnes très âgées si leur risque fracturairen'est pas très élevé.Dans toutes ces situations, le partage de la décision entre lepraticien et son patient prime sur les éventuelles propositionsissues d'algorithmes qui doivent encore être améliorés