Le polmoniti acute acquisite in comunità (PAC) sono patologie respiratorie infettive frequenti e potenzialmente gravi, sia per la virulenza del patogeno causale che per la fragilità delle condizioni ...del paziente. La valutazione della gravità della lesione deve essere sistematica per consentire l’orientamento e la gestione più appropriati. La mortalità ospedaliera delle polmoniti acute gravi acquisite in comunità rimane elevata e può superare il 25% in terapia intensiva. Dal momento che un ritardo nella cura è associato a un aumento di questa mortalità, sono stati sviluppati numerosi sistemi di punteggio per aiutare meglio nell’orientamento del paziente. Lo Streptococcus pneumoniae rimane il patogeno il più delle volte responsabile delle PAC gravi di origine batterica. Più recentemente, lo sviluppo di tecniche di PCR (polymerase chain reaction) multiplex ha individuato l’insorgenza di numerosi virus patogeni responsabili di PAC potenzialmente gravi. La terapia antibiotica è un’emergenza e deve sistematicamente coprire S. pneumoniae e Legionella pneumophila. L’antibiotico di scelta in questo contesto è una cefalosporina di terza generazione, mentre il secondo antibiotico può essere un macrolide. Si noti, tuttavia, l’aumento del numero di PAC (circa il 6%) causate da patogeni resistenti agli antibiotici, raggruppati sotto il termine PES (Pseudomonas aeruginosa, enterobatteri produttori di betalattamasi a spettro esteso BLSE, Staphylococcus aureus resistente alla meticillina), cosa che richiede quindi delle considerazioni specifiche nella scelta della terapia antibiotica appropriata.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta variant was classified as a variant of concern in May 2021 due to its increased transmissibility. It became dominant in Europe ...during the summer, raising concerns on the effectiveness of vaccines. We assessed the vaccine effectiveness (VE) of mRNA BNT162b2 (BioNTech-Pfizer) against SARS-CoV-2 Delta variant during an outbreak affecting long-term care facility (LTCF) residents in southern France, May 2021.
We conducted a retrospective cohort study among LTCF residents. We described sex, age, dependency level, reverse transcription PCR and sequencing results, clinical evolution, vaccination status. We compared attack rates of SARS-CoV-2 infection, symptomatic coronavirus disease 2019 (COVID-19), and severe COVID-19 (respiratory support, hospitalization, and/or death) by vaccination status (two doses administered vs. none) to estimate VE (1 - Relative Risk RR) with 95% confidence intervals (CI). VE was adjusted by age (Poisson regression).
Among 72 LTCF residents, 75.0% (n=54) were women, mean age was 88.7 (SD 8.1) years, 69% (n=49/71) were severely dependent. SARS-CoV-2 infections were identified in 39 residents (54.2%), 11 with symptomatic, and eight with severe COVID-19. All sequenced samples (n=19, 48.7%) had the same Delta variant genomic sequence. Age-adjusted BNT162b2 VE against SARS-CoV-2 Delta variant infection was 11.2% (95% CI: 0.0-61.1%), it was 88.4% (95% CI: 59.9-96.7%) against symptomatic, and 93.5% (95% CI: 67.2-98.7%) against severe COVID-19.
We found a high BNT162b2 VE against symptomatic and severe COVID-19 caused by SARS-CoV-2 Delta variant among LTCF elderly residents, but not against Delta variant infection. This supports vaccination rollout and the implementation of control measures for close contacts among vaccinated LTCF elderly residents.
Mature grapevine berries at the harvesting stage (MB) are very susceptible to the gray mold fungus Botrytis cinerea, while veraison berries (VB) are not. We conducted simultaneous microscopic and ...transcriptomic analyses of the pathogen and the host to investigate the infection process developed by B. cinerea on MB versus VB, and the plant defense mechanisms deployed to stop the fungus spreading. On the pathogen side, our genome-wide transcriptomic data revealed that B. cinerea genes upregulated during infection of MB are enriched in functional categories related to necrotrophy, such as degradation of the plant cell wall, proteolysis, membrane transport, reactive oxygen species (ROS) generation, and detoxification. Quantitative-polymerase chain reaction on a set of representative genes related to virulence and microscopic observations further demonstrated that the infection is also initiated on VB but is stopped at the penetration stage. On the plant side, genome-wide transcriptomic analysis and metabolic data revealed a defense pathway switch during berry ripening. In response to B. cinerea inoculation, VB activated a burst of ROS, the salicylate-dependent defense pathway, the synthesis of the resveratrol phytoalexin, and cell-wall strengthening. On the contrary, in infected MB, the jasmonate-dependent pathway was activated, which did not stop the fungal necrotrophic process.
To determine the relationship between quantitative Doppler parameters of portal, hepatic, and splanchnic circulation and hepatic venous pressure gradient (HVPG), variceal size, and Child–Pugh class ...in patients with alcoholic cirrhosis, we studied forty patients with proved alcoholic cirrhosis who underwent Doppler ultrasonography, hepatic vein catheterization, and esophagoscopy. The following Doppler parameters were recorded: time‐averaged mean blood velocity, volume flow of the main portal vein flow, and resistance index (RI) of the hepatic and of the superior mesenteric artery. Doppler findings were compared with HVPG, presence and size of esophageal varices, and Child–Pugh class. There was a significant inverse correlation between portal velocity and HVPG (r = −.69), as well as between portal vein flow and HVPG (r = −.58). No correlation was found between RI in the hepatic artery or superior mesenteric artery and HVPG. No correlation was found between portal vein measurements and presence and size of varices. Severe liver failure was associated with lower portal velocity and flow. In patients with alcoholic cirrhosis, only portal vein blood velocity and flow, but neither hepatic nor mesenteric artery RI, are correlated to the severity of portal hypertension and to the severity of liver failure.
To evaluate the accuracy of dynamic, contrast material-enhanced computed tomography (CT) in the diagnosis of acute mesenteric ischemia.
Reviewers blinded to patient diagnoses retrospectively compared ...the CT scans in a study group with those in a control group. The study group comprised 39 consecutive patients (23 men, 16 women; aged 55-88 years) with surgically proved acute mesenteric ischemia. The control group comprised 24 patients (13 men, 11 women; aged 50-82 years) with suspected acute mesenteric ischemia that was disproved at surgery.
For the diagnosis of acute mesenteric ischemia, each of the following findings had a specificity of more than 95% and a sensitivity of less than 30%: arterial or venous thrombosis, intramural gas, portal venous gas, focal lack of bowel-wall enhancement, and liver or splenic infarcts. When CT was used in the diagnosis of suspected acute mesenteric ischemia, the detection of at least one of these signs resulted in a sensitivity of 64% (25 of 39; confidence interval, 0.49, 0.79), a specificity of 92% (22 of 24; confidence interval, 0.81, 1.00), and an accuracy of 75% (47 of 63; confidence interval, 0.64, 0.86).
Dynamic, contrast-enhanced CT is a valuable tool in the diagnosis of and determination of prognosis in acute mesenteric ischemia.
International literature suggests that active perinatal management at extremely low gestational ages improves survival without increasing the risk of impairment in survivors, compared to less active ...management. Although these results are limited to a small number of countries, they question current practices in France. New propositions on perinatal management of extremely preterm infants have carried out by the French Society of Perinatal Medicine, the French Society of Neonatology and the National College of French Obstetricians and Gynecologists.
This group was set up in 2015 on the initiative of the professional societies and in collaboration with parents' and users' associations. The work was based on a review of the literature on the prognosis of extremely preterm children, as well as on recommendations by European societies. Based on this information, a text was produced, submitted to all members of the working group and definitively validated in April 2019.
This text offers a decision-making guideline for the management at extremely low gestational ages. Its principles are: the administration of steroids independently of management (resuscitation or comfort care); a prognostic evaluation and a collegial decision, outside the context of the emergency; a consensus on the information to be given to parents before going to inform them and gather their opinion.
These new propositions will contribute to modifying perinatal care at extremely low gestational ages in France.
JARID2, located on chromosome 6p22.3, is a regulator of histone methyltransferase complexes that is expressed in human neurons. So far, 13 individuals sharing clinical features including intellectual ...disability (ID) were reported with de novo heterozygous deletions in 6p22-p24 encompassing the full length JARID2 gene (OMIM 601594). However, all published individuals to date have a deletion of at least one other adjoining gene, making it difficult to determine if JARID2 is the critical gene responsible for the shared features. We aim to confirm JARID2 as a human disease gene and further elucidate the associated clinical phenotype.
Chromosome microarray analysis, exome sequencing, and an online matching platform (GeneMatcher) were used to identify individuals with single-nucleotide variants or deletions involving JARID2.
We report 16 individuals in 15 families with a deletion or single-nucleotide variant in JARID2. Several of these variants are likely to result in haploinsufficiency due to nonsense-mediated messenger RNA (mRNA) decay. All individuals have developmental delay and/or ID and share some overlapping clinical characteristics such as facial features with those who have larger deletions involving JARID2.
We report that JARID2 haploinsufficiency leads to a clinically distinct neurodevelopmental syndrome, thus establishing gene-disease validity for the purpose of diagnostic reporting.
OBJECTIVES:Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early ...predictors of convulsive status epilepticus–related cardiac arrest.
DESIGN:Retrospective multicenter study.
SETTING:Seventeen university or university affiliated participating ICUs in France and Belgium.
PATIENTS:Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus between 2000 and 2015. Patients were compared with controls without cardiac arrest identified in a single-center registry of convulsive status epilepticus patients, regarding characteristics, management, and outcome.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We included 49 cases with convulsive status epilepticus–cardiac arrest and 235 controls. In the cases, median time from medical team arrival to cardiac arrest was 25 minutes (interquartile range, 5–85 min). First recorded rhythm was asystole in 25 patients (51%) and pulseless electrical activity in 13 patients (27%). A significantly larger proportion of patients had a favorable 1-year outcome (Glasgow Outcome Scale score of 5) among controls (90/235; 38%) than among cases (10/49; 21%; p = 0.02). By multivariate analysis, independent predictors of cardiac arrest were pulse oximetry less than 97% on scene (odds ratio, 2.66; 95% CI, 1.03–7.26; p = 0.04), drug poisoning as the cause of convulsive status epilepticus (odds ratio, 4.13; 95% CI, 1.27–13.53; p = 0.02), and complications during early management (odds ratio, 11.98; 95% CI, 4.67–34.69; p < 0.0001). Having at least one comorbidity among cardiac, respiratory, and neurologic (other than epilepsy) conditions predicted absence of cardiac arrest (odds ratio, 0.28; 95% CI, 0.10–0.80; p = 0.02).
CONCLUSIONS:In patients managed for convulsive status epilepticus, relative hypoxemia, on-scene management complications, and drug poisoning as the cause of convulsive status epilepticus were strong early predictors of cardiac arrest, suggesting areas for improvement.
Summary
Since the dawn of quantum computing (QC), theoretical developments like Shor's algorithm proved the conceptual superiority of QC over traditional computing. However, such quantum supremacy ...claims are difficult to achieve in practice because of the technical challenges of realizing noiseless qubits. In the near future, QC applications will need to rely on noisy quantum devices that offload part of their work to classical devices. One way to achieve this is by using parameterized quantum circuits in optimization or even in machine learning tasks. The energy requirements of quantum algorithms have not yet been studied extensively. In this article, we explore several optimization algorithms using both theoretical insights and numerical experiments to understand their impact on energy consumption. Specifically, we highlight why and how algorithms like quantum natural gradient descent, simultaneous perturbation stochastic approximations or circuit learning methods, are at least to more energy efficient than their classical counterparts; why feedback‐based quantum optimization is energy‐inefficient; and how techniques like Rosalin can improve the energy efficiency of other algorithms by a factor of 20. Finally, we use the NchooseK high‐level programming model to run optimization problems on both gate‐based quantum computers and quantum annealers. Empirical data indicate that these optimization problems run faster, have better success rates, and consume less energy on quantum annealers than on their gate‐based counterparts.
Abstract Ottenheijm RP, Jansen MJ, Staal JB, van den Bruel A, Weijers RE, de Bie RA, Dinant G-J. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic ...review and meta-analysis. Objective To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings. Data Sources Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included articles were searched to identify relevant studies. Study Selection Two reviewers independently selected the articles evaluating the accuracy of ultrasound for detecting subacromial disorders from the title and abstracts retrieved by the literature search. Selection criteria were ultrasound frequency greater than or equal to 7.5MHz as index test, surgery, magnetic resonance imaging and/or radiography as reference standards, and subacromial disorders as target conditions. Data Extraction Two reviewers independently extracted the data on study characteristics and results to construct 2 by 2 tables and performed a methodologic quality assessment. Data Synthesis Twenty-three studies were included: 22 reported on full-thickness rotator cuff tears, 15 on partial-thickness tears, 3 on subacromial bursitis, 2 on tendinopathy, and 2 on calcifying tendonitis, respectively. For full-thickness tears, pooled sensitivity of ultrasound was .95 (95% confidence interval, .90–.97), and specificity .96 (.93–.98). For partial-thickness tears, pooled sensitivity was .72 (.58–.83), and specificity .93 (.89–.96). Statistical pooling was not possible for the other disorders. For subacromial bursitis, sensitivity ranged from .79 to .81, and specificity from .94 to .98. For tendinopathy, sensitivity ranged from .67 to .93, specificity from .88 to 1.00. Sensitivity for calcifying tendonitis was 1.00 in both studies, with specificity ranging from .85 to .98. Conclusions We strongly recommend ultrasound in patients for whom conservative treatment fails, to rule in or out full-thickness tears, to rule in partial-thickness tears, and to a lesser extent to diagnose tendinopathy, subacromial bursitis, and calcifying tendonitis. These results can help physicians tailor treatment.
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