Endothelin-1 Predicts Hemodynamically Assessed Pulmonary Arterial Hypertension in HIV Infection.

BackgroundHIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. ET-1 is a robust vasoconstrictor and key mediator of pulmonary vascular homeostasis. Higher levels of ET-1 predict disease severity and mortality in other forms of PAH, and endothelin receptor antagonists are central to treatment, including in HIV-associated PAH. The direct relationship between ET-1 and PAH in HIV-infected individuals is not well described.MethodsWe measured ET-1 and estimated pulmonary artery systolic pressure (PASP) with transthoracic echocardiography (TTE) in 106 HIV-infected individuals. Participants with a PASP ≥ 30 mmHg (n = 65) underwent right heart catheterization (RHC) to definitively diagnose PAH. We conducted multivariable analysis to identify factors associated with PAH.ResultsAmong 106 HIV-infected participants, 80% were male, the median age was 52 years and 77% were on antiretroviral therapy. ET-1 was significantly associated with higher values of PASP [14% per 0.1 pg/mL increase in ET-1, p = 0.05] and PASP ≥ 30 mmHg [PR (prevalence ratio) = 1.24, p = 0.012] on TTE after multivariable adjustment for PAH risk factors. Similarly, among the 65 individuals who underwent RHC, ET-1 was significantly associated with higher values of mean pulmonary artery pressure and PAH (34%, p = 0.003 and PR = 2.43, p = 0.032, respectively) in the multivariable analyses.ConclusionsHigher levels of ET-1 are independently associated with HIV-associated PAH as hemodynamically assessed by RHC. Our findings suggest that excessive ET-1 production in the setting of HIV infection impairs pulmonary endothelial function and contributes to the development of PAH

Novel computed tomographic chest metrics to detect pulmonary hypertension

<p>Abstract</p> <p>Background</p> <p>Early diagnosis of pulmonary hypertension (PH) can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC) for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT) of the chest may be an alternative non-invasive method of detecting PH.</p> <p>Methods</p> <p>This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's.</p> <p>Results</p> <p>Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA) diameter ≥29 mm (odds ratio (OR) = 4.8), right descending PA diameter ≥19 mm (OR = 7.0), true right descending PA diameter ≥ 16 mm (OR = 4.1), true left descending PA diameter ≥ 21 mm (OR = 15.5), right ventricular (RV) free wall ≥ 6 mm (OR = 30.5), RV wall/left ventricular (LV) wall ratio ≥0.32 (OR = 8.8), RV/LV lumen ratio ≥1.28 (OR = 28.8), main PA/ascending aorta ratio ≥0.84 (OR = 6.0) and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7) were significant predictors of PH in this population of hospitalized patients.</p> <p>Conclusion</p> <p>This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients.</p

Right-to-left shunt with hypoxemia in pulmonary hypertension

<p>Abstract</p> <p>Background</p> <p>Hypoxemia is common in pulmonary hypertension (PH) and may be partly related to ventilation/perfusion mismatch, low diffusion capacity, low cardiac output, and/or right-to-left (RL) shunting.</p> <p>Methods</p> <p>To determine whether true RL shunting causing hypoxemia is caused by intracardiac shunting, as classically considered, a retrospective single center study was conducted in consecutive patients with precapillary PH, with hypoxemia at rest (PaO₂< 10 kPa), shunt fraction (Qs/Qt) greater than 5%, elevated alveolar-arterial difference of PO₂(AaPO₂), and with transthoracic contrast echocardiography performed within 3 months.</p> <p>Results</p> <p>Among 263 patients with precapillary PH, 34 patients were included: pulmonary arterial hypertension, 21%; PH associated with lung disease, 47% (chronic obstructive pulmonary disease, 23%; interstitial lung disease, 9%; other, 15%); chronic thromboembolic PH, 26%; miscellaneous causes, 6%. Mean pulmonary artery pressure, cardiac index, and pulmonary vascular resistance were 45.8 ± 10.8 mmHg, 2.2 ± 0.6 L/min/m², and 469 ± 275 dyn.s.cm^-5, respectively. PaO₂in room air was 6.8 ± 1.3 kPa. Qs/Qt was 10.2 ± 4.2%. AaPO₂under 100% oxygen was 32.5 ± 12.4 kPa. Positive contrast was present at transthoracic contrast echocardiography in 6/34 (18%) of patients, including only 4/34 (12%) with intracardiac RL shunting. Qs/Qt did not correlate with hemodynamic parameters. Patients' characteristics did not differ according to the result of contrast echocardiography.</p> <p>Conclusion</p> <p>When present in patients with precapillary PH, RL shunting is usually not related to reopening of patent <it>foramen ovale</it>, whatever the etiology of PH.</p

National cultural autonomy and linguistic rights in Central and Eastern Europe

The theory and practice of national cultural autonomy (NCA) are examined from the perspective of national minorities’ linguistic rights in four countries of Central and Eastern Europe (CEE): Hungary, Estonia, Serbia and Russia. The idea of NCA dates back to the end of the nineteenth century and is based on the principle of ethnic communities’ autonomy—within a multi-ethnic state—to manage their own linguistic and cultural affairs. The notion of NCA was rediscovered in the 1990s and incorporated into the law and practice of the said four countries. Using a comparative approach, the chapter reflects upon NCA’s potential contribution in advancing the linguistic rights of national minorities in CEE. It concludes that, while the actual autonomy afforded to minority institutions in CEE is often restricted, NCA may serve as a platform to articulate concerns of great salience to national minorities, encompassing minority participation and multilingual education

(The lexical quality of texts produced at the end of primary school and the influence of the socio-economic context)

The article presents the results of a comparative study of texts produced by students from contrasting socio-economic backgrounds in the last stage of primary school. The analysis of students’ written productions concentrates on lexical choices and spelling decisions in relation to standard spelling. A total of 105 students attending the sixth grade of primary school (63 from disadvantaged backgrounds, 42 from privileged backgrounds) completed a written production test based on a sequential illustrated narrative. The results reveal differences between socio-economic backgrounds in terms of the percentage of lexical spelling errors in written productions but not in terms of vocabulary diversity

Enhanced natural radioactivity in leachate and groundwater of Belgian landfills

To investigate the potential impact on ground- or surface water of natural radionuclides present in waste disposed onto landfills, activity concentrations in leachates, waste water treatment plant discharge and groundwater of several landfills in Belgium have been analysed. 16 currently in operation landfills for hazardous and non-hazardous waste and 10 legacy landfills have been investigated. Results indicate the presence of a slightly enhanced concentration of uranium and other radionuclides in some leachates of landfills in operation. For legacy landfills, enhanced uranium concentration is also observed in some groundwater wells. The presence of uranium in groundwater around landfills is always accompanied by a contamination with other heavy metals and chlorides. No clear linear correlation between concentration of uranium and other metals could be found however. Isotopic ratio between U-238 and U-234 has been calculated in the different water matrices and is close to one in contaminated groundwater, probably indicating an anthropogenic contamination. In all cases, the concentrations of natural radionuclides do not reach values of concern from radiation protection point of view

L’anaphylaxie alimentaire chez le sénior : analyse des données du RAV de 2002 à 2020

Entre 2002 et 2020, 172 anaphylaxies alimentaires observées chez le sénior ont été rapportées au RAV. On observe un sex-ratio H/F de 0,85 et une moyenne d’âge de 67,3 ans (60–93). Les allergènes les plus fréquents sont d’origine végétale : en premier, les légumineuses (20 cas), puis les céréales (16 cas) et les fruits à coque (15 cas), principalement la noisette. Les protéines PR-10 sont en cause dans au moins 11,7 % des anaphylaxies. À l’instar du soja, les anaphylaxies attribuées à Cor a 1 sont surtout rapportées par des allergologues exerçant en Belgique et dans le nord-est de la France. Les anaphylaxies liées aux viandes rouges et abats sont les plus fréquentes (24 cas soit 13,9 %), toujours associées à un syndrome alphaGal quand il est recherché, 16 sont attribuées aux crustacés, 8 aux mollusques et aux poissons respectivement et 6 cas à Anisakis. Cette série confirme la rareté de l’allergie au lait de vache et à l’œuf chez le sénior. Le RAV a colligé 4 anaphylaxies de grade I, 77 de grade II, 84 de grade III et 5 de grade IV dont un décès. La gravité est significativement liée à des antécédents de cardiopathie ou HTA. Quarante pour cent des sujets avaient déjà présenté une allergie dans le passé avec l’aliment suspecté et seulement 55 % disposaient d’un stylo d’adrénaline et 33 % d’un plan d’action. Cette grande série souligne l’intérêt d’un bilan allergologique détaillé chez le sujet âgé. Leur prise en charge doit non seulement comporter un protocole de soins d’urgence avec auto-injecteur d’adrénaline, mais aussi une éducation thérapeutique et diététique pour le patient et son entourage. Elle devrait être formalisée par un PAI, à l’instar de l’enfant scolarisé, compte tenu du risque de récidive, des comorbidités et perte d’autonomie pour certains

An epidemic of allergic contact dermatitis due to epilating products.

Over a period of 19 months, 33 cases of acute allergic contact dermatitis from Veet epilating waxes and/or the accompanying tissue (Reckitt Benckiser, Massy, France) were observed in France and Belgium. The lesions started on the legs and spread to other parts of the body, especially the face, and were sometimes so severe that hospitalization and/or systemic corticosteroids were required. Primary sensitization occurred as early as after the first application in several patients. Patch tests were performed in 26 of the patients and produced strong positive reactions to the tissue (25 times) and/or the wax (13 times). The allergenic culprits in the wax were modified-colophonium derivatives (colophonium in the standard series testing negatively in all except 4 patients), while methoxy PEG-22/dodecyl glycol copolymer and to a lesser degree lauryl alcohol turned out to be the main causal allergens in the tissue