primary lymphomas of the genitourinary tract a population based study

Abstract Objective We performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL). Methods We identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998–2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used. Results The rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: −5.6%; p = 0.004) and prostate-PL (EAPC: −3.6%; p = 0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p Conclusion PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Impact de la survenue d'une lésion tertiaire sur le pronostic fonctionnel après un traumatisme crânien grave : étude longitudinale en imagerie par résonance magnétique (I.R.M)

Objectif : le Traumatisme Crânien (TC) ne semble pas être une pathologie dont la lésion évolue de manière monophasique. Dernièrement, plusieurs travaux ont émis l’hypothèse que des phénomènes neurodégénératifs pourraient jouer un rôle sur le pronostic à long terme. L’objectif de cette étude était d’évaluer longitudinalement chez les TC graves la survenue de lésions tertiaires par l’étude de l’évolution des volumes de substance blanche et de substance grise en imagerie par résonance magnétique (IRM) anatomique ainsi que l'intégrité de la substance blanche évaluée par Tenseur de Diffusion (DTI).Matériels et méthodes : Il s’agit d’une étude de cohorte observationnelle portant sur des patients de réanimation avec un traumatisme crânien grave (TCG) et troubles de la conscience prolongés d’au moins 7 jours. Les patients comportaient un suivi clinique et d’imagerie par IRM en phase subaiguë et chronique.Résultats : entre octobre 2006 et avril 2013, 22 TCG (30±13 ans) et 11 volontaires sains (VS; 42±6 ans) ont été suivis longitudinalement. Les TCG ont eu une IRM pendant leur séjour en soins critique (21±8 jours après le traumatisme) puis une seconde plusieurs années après à la phase chronique (médiane 64±16 mois après le traumatisme) le jour d’une évaluation neuropsychologique. Le Glasgow Outcome Scale étendu (GOSE) a été utilisé pour classer les TC en "bonne" évolution (GOSE6-7 ; n=10) et évolution "intermédiaire" (GOSE3-5 ; n=12). Sur l’IRM de suivi, les TC graves présentaient une réduction volumétrique significative de substance blanche (-11,4% [-5,8 ; -14,6] ; p<0,001) et des noyau gris centraux (-17,1% [-10,6 ; -20,5] ; p<0,001). Plus précisément, les GOSE3-5 présentaient une plus grande atrophie avec le temps que le GOSE6-7 au niveau du tronc cérébral (-14,1% [-8,2 ;-24,5] vs (-7,1% [-1,2 ;-11,9] ; p<0,001), l’hippocampe droit (-13,4% [-5,9 ;-17,6] vs -4,8% [-0,1 ;-9,3]; p<0,001) et le pédoncule cérébral gauche (-18,7% [-5,0 ;-41,8] vs -4,6% [-9,1 ;5,2]; p=0,03). Ces lésions étaient associées à un profil spécifique en DTI avec une FA plus faible et une MD, AD, RD plus élevées. Le modèle de pronostication obtenue avec la MD en phase subaiguë montre une bonne performance pronostique pour la prédiction de l’évolution neurologique (surface sous la courbe ROC 0,98, (IC95% 0,88-1,00) avec une sensibilité de 95% (IC95% 92-99) et une spécificité de 99 % (IC95% 97-100)).Conclusion : nous avons observé à distance du traumatisme crânien la survenue d’une importante atrophie de la substance blanche et des noyaux gris centraux qui respectait néanmoins le cortex cérébral, avec un effet plus important sur certaines structures en fonction de l’évolution neurologique.À la phase subaiguë, les lésions étaient associées à un profil spécifique en DTI qui pouvait être utilisé pour prédire le devenir neurologique des patients

Tertiary lesion after severe traumatic brain injury : a magnetic resonance imaging study

Le traumatisme crânien est une affection neurologique dont l’incidence est une cause majeure de mortalité et de morbidité dans le monde allant jusqu'à 80% de handicap pour les patients ayant présentés un TC grave (TCG). Malgré la complexité et l'hétérogénéité des lésions initiales, des mécanismes neurodégénératifs apparaissant à distance de la phase initiale sous la forme d’entités physiopathologiques appelées "lésions tertiaires" ont été mis en évidence. Ces mécanismes sembleraient présenter des similitudes avec les maladies inflammatoires et neurodégénératives à type de démence. Notre premier travail a permis de caractériser l'atrophie marquée des structures cérébrales profondes consécutive à un TCG. L'imagerie IRM comprenant un DTI dans la phase subaiguë permettrait de prédire l'apparition et la localisation de ces lésions tertiaires ainsi que le résultat neurologique à long terme. Notre deuxième travail a montré une incidence élevée de lésions sur le circuit de Papez suite à TCG associé à des troubles de la mémoire épisodique. L’IRM avec DTI du circuit de Papez constituerait un outil pertinent pour le diagnostic de troubles de la mémoire chez les patients ayant subi un TCG. Ces résultats peuvent contribuer à l'identification précoce des patients présentant des troubles de la mémoire et à leur réhabilitation. Ces travaux permettent de mieux comprendre la physiopathologie précoce et tardive des TCG en explorant la relation entre l'intégrité structurelle évaluée par IRM comprenant un DTI et les désordres cognitifs induits. Les techniques utilisées présentent un intérêt clair en tant que biomarqueur pour le suivi de ces patients et l'étude des thérapies neuroprotectrices.Traumatic brain injury (TBI) is a neurological disorder whose incidence is a major cause of mortality and morbidity in the world, with up to 80% of disability for patients who have suffered a severe TBI. Despite the complexity and heterogeneity of the initial lesions, neurodegenerative mechanisms appearing at a distance from the initial phase in the form of physiopathological entities called "tertiary lesions" have been highlighted. These mechanisms seem to have similarities with inflammatory and neurodegenerative diseases such as dementia. Our first work allowed us to characterize the marked atrophy of deep brain structures following a severe TBI. MRI imaging including DTI in the subacute phase would predict the onset and location of these tertiary lesions as well as the long-term neurological outcome. Our second work showed a high incidence of lesions on the Papez circuit following a severe TBI associated with episodic memory disorders. MRI with DTI of the Papez circuit would be a relevant tool for the diagnosis of episodic memory disorders in patients with a severe TBI. These results may contribute to the early identification of patients with memory disorders and their rehabilitation. This work provides a better understanding of the early and late pathophysiology of severe TBI by exploring the relationship between structural integrity assessed by MRI including DTI and induced cognitive disorders. The techniques used are of clear interest as biomarkers for the follow-up of these patients and the study of neuroprotective therapies

NIRS: a gadget or a must for critically ill patients?

International audienc

Afsaruddin Asma, Zahniser A. H. Mathias, Ed., Humanism, Culture & Language in the Near East – Studies in Honour of Georg Krotkoff. Winona Lake (Indiana), Eisenbrauns, 1997

Simeone-Senelle Marie-Claude, Lory Pierre. Afsaruddin Asma, Zahniser A. H. Mathias, Ed., Humanism, Culture & Language in the Near East – Studies in Honour of Georg Krotkoff. Winona Lake (Indiana), Eisenbrauns, 1997. In: Bulletin critique des annales islamologiques, n°17, 2001. pp. 1-2

Polynomial algorithms for nested univariate clustering

AbstractClique partitioning in Euclidean space Rn consists in finding a partition of a given set of N points into M clusters in order to minimize the sum of within-cluster interpoint distances. For n=1 clusters need not consist of consecutive points on a line but have a nestedness property. Exploiting this property, an O(N5M2) dynamic programming algorithm is proposed. A θ(N) algorithm is also given for the case M=2