Hyper-IgG4 disease: report and characterisation of a new disease

BACKGROUND: We highlight a chronic inflammatory disease we call 'hyper-IgG4 disease', which has many synonyms depending on the organ involved, the country of origin and the year of the report. It is characterized histologically by a lymphoplasmacytic inflammation with IgG4-positive cells and exuberant fibrosis, which leaves dense fibrosis on resolution. A typical example is idiopathic retroperitoneal fibrosis, but the initial report in 2001 was of sclerosing pancreatitis. METHODS: We report an index case with fever and severe systemic disease. We have also reviewed the histology of 11 further patients with idiopathic retroperitoneal fibrosis for evidence of IgG4-expressing plasma cells, and examined a wide range of other inflammatory conditions and fibrotic diseases as organ-specific controls. We have reviewed the published literature for disease associations with idiopathic, systemic fibrosing conditions and the synonyms: pseudotumour, myofibroblastic tumour, plasma cell granuloma, systemic fibrosis, xanthofibrogranulomatosis, and multifocal fibrosclerosis. RESULTS: Histology from all 12 patients showed, to varying degrees, fibrosis, intense inflammatory cell infiltration with lymphocytes, plasma cells, scattered neutrophils, and sometimes eosinophilic aggregates, with venulitis and obliterative arteritis. The majority of lymphocytes were T cells that expressed CD8 and CD4, with scattered B-cell-rich small lymphoid follicles. In all cases, there was a significant increase in IgG4-positive plasma cells compared with controls. In two cases, biopsies before and after steroid treatment were available, and only scattered plasma cells were seen after treatment, none of them expressing IgG4. Review of the literature shows that although pathology commonly appears confined to one organ, patients can have systemic symptoms and fever. In the active period, there is an acute phase response with a high serum concentration of IgG, and during this phase, there is a rapid clinical response to glucocorticoid steroid treatment. CONCLUSION: We believe that hyper-IgG4 disease is an important condition to recognise, as the diagnosis can be readily verified and the outcome with treatment is very good

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

« Adaptation de l'Intervention Psychothérapeutique Post-Immédiate aux enfants au moyen de l'utilisation pratique d'un média dans un entretien structuré »

International audienceObjectives: A lack of experience for early post-traumatic interventions for children was observed after the terrorist attacks perpetrated in 2015 and 2016 in France. The clinicians involved in the medico psychological emergency units (CUMP) had to quickly adapt their interventions to help children and their families seeking assistance. This article aims to examine how the Post-Immediate Psychotherapeutic Intervention (IPPI) based on the debriefing technique commonly used by the CUMP could be adapted to this age. Patients and method: This article describes a modified form of the IPPI interview for children based on the use of pictorial representations, i.e., the Metaphoric and Associative Cards, “OH-Cards”. A clinical vignette illustrates the different steps of this intervention such as those provided to sibling 6-year-old twins in the context of a post-immediate CUMP intervention after a drowning. Results: Adding the pictorial cards to IPPI interview techniques facilitated the children's verbalization, the narrative reports of the traumatic experience with the professional, and globally enhanced the symbolization process. Discussion: This developmental-sensitive adaptation of the commonly used debriefing approach illustrates the positive synergy between the professional cultures of the clinicians from the CUMP and the child psychiatrists. Conclusion: Children-specific adaptations of the IPPI based on symbolic mediators, such as pictorial cards, should be considered as a reference tool at this age in the training of CUMP professionals

Feasibility study of 235U and 239Pu characterization in radioactive waste drums using neutron-induced fission delayed gamma rays

International audienceThis paper reports a feasibility study of 235U and 239Pu characterization in 225 L bituminized waste drums or 200 L concrete waste drums, by detecting delayed fission gamma rays between the pulses of a deuterium-tritium neutron generator. The delayed gamma yields were first measured with bare samples of 235U and 239Pu in REGAIN, a facility dedicated to the assay of 118 L waste drums by Prompt Gamma Neutron Activation Analysis (PGNAA) at CEA Cadarache, France. Detectability in the waste drums is then assessed using the MCNPX model of MEDINA (Multi Element Detection based on Instrumental Neutron Activation), another PGNAA cell dedicated to 200 L drums at FZJ, Germany. For the bituminized waste drum, performances are severely hampered by the high gamma background due to 137Cs, which requires the use of collimator and shield to avoid electronics saturation, these elements being very penalizing for the detection of the weak delayed gamma signal. However, for lower activity concrete drums, detection limits range from 10 to 290 g of 235U or 239Pu, depending on the delayed gamma rays of interest. These detection limits have been determined by using MCNPX to calculate the delayed gamma useful signal, and by measuring the experimental gamma background in MEDINA with a 200 L concrete drum mock-up. The performances could be significantly improved by using a higher interrogating neutron emission and an optimized experimental setup, which would allow characterizing nuclear materials in a wide range of low and medium activity waste packages

Implementation of a complex monitoring system to track people in the ATLAS detector

International audienceTLAS is one of the four large experiments at the Large Hadron Collider at CERN. The detector itself and the surrounding structures in the cavern of the experiment are accessible for people during maintenance periods. People can easily be isolated and difficult to localize in which case their safety may be compromised in this very complex environment. Therefore a dedicated system called ¿Finding Persons Inside ATLAS Areas¿ has been designed and implemented to track persons in the experimental cavern. It is based on a network of passive infrared sensors which are read out by specific front-end electronics. A complex software architecture provides active tracking of people in the cavern with the possibility to detect abnormal situations where people are possibly in danger. This paper describes the technological choices which have been made for this monitoring system and explains the implementation of the software components. This provides a tool for the operation in the control room of ATLAS to actively follow people in the cavern underground. As the system is data-driven, it can be easily adapted to other environments where similar safety problems exist

The Hidden Midden: Geoarchaeological investigation of sedimentation processes, waste disposal practices, and resource management at the La Tène settlement of Basel‐Gasfabrik (Switzerland)

To interpret artifact assemblages, it is necessary to understand the processes that have formed and influenced them: layer formation processes, cultural practices, and the way resources were used. In this study, we present our results of micromorphologically analyzed pits, ditches, house floors, and occupation layers found within the younger Iron Age settlement of Basel‐Gasfabrik. We defined 11 microfacies types and put them into a spatial and stratigraphic context. In addition, we quantify waste categories according to the archaeological features and microfacies types. Our results suggest that some ditches played a role in the spatial organization of the settlement, others were used as water canals. Several pits show a secondary use as roofed construction in the context of handicrafts. In addition, mapping the microfacies types reveals a differentiated use of space. Finally, differences between waste categories are visible. Dung was used as fuel and probably as fertilizer, whereas animal bone fragments and ceramic sherds have been stored on rubbish dumps, where they were available as raw material. These new insights into the use of pits, ditches, and settlement areas as well as the handling of resources provide an important basis for understanding everyday life in the settlement of Basel‐Gasfabrik