Intra-arterial vasodilators infusion for management of reversible cerebral vasoconstriction syndrome in a 12-year-old girl: A case report.

Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular disease characterized by diffuse transient vasoconstriction and vasodilatation of the cerebral arteries. It is commonly associated with recurrent severe acute headaches with or without focal neurological deficits due to hemorrhages, infarcts, and even posterior reversible encephalopathy syndrome. The optimal management of acute neurologic deficits caused by RCVS is still uncertain. Calcium channel blockers (CCBs) such as nimodipine or verapamil have been reported to be effective in adult series. Intra-arterial injection of nimodipine, verapamil, and milrinone has recently been demonstrated to be safe and effective for treating severe segmental vasoconstriction in adults. CCBs are the most used treatment in the available pediatric literature. Intra-arterial vasodilators have been reported in some rare pediatric reports with more severe diseases, but their utility is still under investigation. We report a case of a 12-year-old girl who underwent a severe course of RCVS complicated by multiple cerebral infarcts, treated by several sessions of intra-arterial vasodilators infusion

A new dynamic module for in-situ nanomechanical testing at high strain rate

In-situ nanomechanical testing is commonly used to probe surface mechanical properties of bulk materials or thin films, like hardness, Young’s modulus, Yield stress…Actually most of the instruments can measure these properties only statically, i.e. a low frequency, leading to property measurement only at low strain rate (usually 10-1s-1 by nanoindentation). This is mainly caused by the low resonance frequency of the system, preventing making tests at higher speed. Performing high dynamic measurements could bring new information on materials properties like deformation mechanism at high strain rate, or high dynamic fatigue properties. A new high dynamic module usable for in-situ mechanical testing has been developed. It is composed of a small piezotube attached directly behind the tip. Because of the small dimensions of the module, his resonance frequency is very high (higher than 50kHz) in comparison to classical nanomechanical testers, permitting to perform and measure precisely the signals at very high frequency. Moreover, it can be used as a sensor and as an actuator, in x, y and z directions which gives to this module a very large range of measurements. Firstly, the characteristics, the performances and the limits of the new high dynamic module will be presented. Secondly some indentations experiments performed at high strain rate on nanocrystalline nickel with the in-situ nanomechanical tester (Alemnis Gmbh) equipped with the high dynamic will be presented and discussed (Fig. 1). Finally, some micropillar compression at high strain rate on the same material will be described and discussed

Venous thromboembolism in critically Ill patients with COVID-19: Results of a screening study for deep vein thrombosis.

The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and coronavirus disease 2019 (COVID-19), has caused more than 3.9 million cases worldwide. Currently, there is great interest to assess venous thrombosis prevalence, diagnosis, prevention, and management in patients with COVID-19. To determine the prevalence of venous thromboembolism (VTE) in critically ill patients with COVID-19, using lower limbs venous ultrasonography screening. Beginning March 8, we enrolled 25 patients who were admitted to the intensive care unit (ICU) with confirmed SARS-CoV-2 infections. The presence of lower extremity deep vein thrombosis (DVT) was systematically assessed by ultrasonography between day 5 and 10 after admission. The data reported here are those available up to May 9, 2020. The mean (± standard deviation) age of the patients was 68 ± 11 years, and 64% were men. No patients had a history of VTE. During the ICU stay, 8 patients (32%) had a VTE; 6 (24%) a proximal DVT, and 5 (20%) a pulmonary embolism. The rate of symptomatic VTE was 24%, while 8% of patients had screen-detected DVT. Only those patients with a documented VTE received a therapeutic anticoagulant regimen. As of May 9, 2020, 5 patients had died (20%), 2 remained in the ICU (8%), and 18 were discharged (72%). In critically ill patients with SARS-CoV-2 infections, DVT screening at days 5-10 of admission yielded a 32% prevalence of VTE. Seventy-five percent of events occurred before screening. Earlier screening might be effective in optimizing care in ICU patients with COVID-19

Leukemoid Reaction in Infant Pertussis: Is There a Place for Hydroxyurea? A Case Report.

A 73-days old infant of 34 weeks' gestation was hospitalized with a co-infection of respiratory syncytial virus (RSV) and <i>Bordetella pertussis (BP)</i> . She required invasive ventilation for 9 days in the context of malignant pertussis with persistent hypoxemia and hypercapnia secondary to a leukemoid reaction. Despite an increase of white blood cell (WBC) count up to 70 G/L and ensuing pulmonary hypertension, no hemodynamic compromise occurred. Without clear indication for leukapheresis nor exchange transfusion, an off-label treatment with hydroxyurea was given for 5 days with gradual decrease of WBC count, without any complication and hospital discharge on day 29. To our knowledge, no effective therapy for malignant pertussis has been described in the literature and complications are frequent with leukoreduction procedures. We discuss an alternative to invasive procedures in young infants to fulfill the need to decrease rapidly leukocyte counts in a leukemoid reaction associated with <i>Bordetella pertussis</i> infection. To our knowledge, hydroxyurea has never been used in malignant pertussis but is a well-known medication for oncologic and hematologic diseases such as acute myeloid leukemia or sickle cell anemia. Its effects in this setting are not well understood but the positive outcome in our patient supports the need for further studies

Bioaccessibility of selenium after human ingestion in relation to its chemical species and compartmentalization in maize

International audienceSelenium is a micronutrient needed by all living organisms including humans, but often present in low concentration in food with possible deficiency. From another side, at higher concentrations in soils as observed in seleniferous regions of the world, and in function of its chemical species, Se can also induce (eco)toxicity. Root Se uptake was therefore studied in function of its initial form for maize (Zea mays L.), a plant widely cultivated for human and animal food over the world. Se phytotoxicity and compartmentalization were studied in different aerial plant tissues. For the first time, Se oral human bioaccessibility after ingestion was assessed for the main Se species (SeIV and SeVI) with the BARGE ex vivo test in maize seeds (consumed by humans), and in stems and leaves consumed by animals. Corn seedlings were cultivated in hydroponic conditions supplemented with 1 mg L−1 of selenium (SeIV, SeVI, Control) for 4 months. Biomass, Se concentration, and bioaccessibility were measured on harvested plants. A reduction in plant biomass was observed under Se treatments compared to control, suggesting its phytotoxicity. This plant biomass reduction was higher for selenite species than selenate, and seed was the main affected compartment compared to control. Selenium compartmentalization study showed that for selenate species, a preferential accumulation was observed in leaves, whereas selenite translocation was very limited toward maize aerial parts, except in the seeds where selenite concentrations are generally high. Selenium oral bioaccessibility after ingestion fluctuated from 49 to 89 % according to the considered plant tissue and Se species. Whatever the tissue, selenate appeared as the most human bioaccessible form. A potential Se toxicity was highlighted for people living in seleniferous regions, this risk being enhanced by the high Se bioaccessibility

Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

© 2016 Hamshere et al. Background: AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). Methods: CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. Results: 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21 %, 95 % limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. Conclusions: AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians

Postoperative outcomes after delayed cholecystectomy for high risk patients with percutaneous drainage for acute cholecystitis

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for acute cholecystitis (AC). In high-risk patients, percutaneous drainage (PD) with delayed cholecystectomy (DC) is an alternative. However, the data on outcomes of patients who underwent DC after PD is scarce. The aim of this study was to compare the outcomes after DC in patients primarily treated either with antibiotics (ATB) or with PD. Methods: Retrospective analysis of all consecutive patients treated primarily either with ATB or PD followed by DC at our institution between January 2006 and December 2015. Patients’ co-morbidities, Charlson index at the time of acute cholecystitis, and DC outcomes (including complication comprehensive index (CCI) after surgery) were analysed. Results: Twenty-eight patients were treated with PD [median age = 77 years (range = 73-87)] and 77 with antibiotics [median age = 78 years (range = 73-83)] at the time of AC. Both groups had a similar Charlson’s comorbidity index at admission. Eighteen patients (64%) initially treated with PD underwent DC, while 10 (36%) required an emergency cholecystectomy (EC) for recurrence (n=1) or treatment failure (n=9). In the ATB group, 53 (69%) patients underwent DC, while 24 (31%) had an EC for recurrence (n=13) or treatment failure (n=11). The length of stay after DC was longer for patients initially treated with PD [26 days (range = 15-48) vs 7 days (range = 4-13) in ATB group, p&lt;0.001]. After DC, PD group had more major complications, and higher CCI compared to the ATB group [3 vs 1 (p = 0,048) and mean 16,4 ± 32.0 vs mean 1,8 ± 5,6 (p = 0,006), respectively]. Conclusion: Percutaneous drainage is an effective initial treatment for acute cholecystitis in patients at high risk for surgery, however delayed cholecystectomy in this group is associated with a higher complications and longer hospital stay compared to patients treated primarily with antibiotics