•Population-based studies based on individual data remains a key report to capture the overall Crohn's disease course.•The identification of early predictor of poor CD disease outcomes remains needed ...to avoid delayed introduction of effective treatments.•A majority of patients developed a Crohn's disease complication.•Perianal disease including non-fiztulizing lesions are the main predictor of disabling disease.
The identification of early prognostic factors during Crohn's disease (CD) remains needed for physician decision-making to minimize structural bowel damage, which this study aimed to assess in a population-based setting.
All incident cases of CD were prospectively registered from 1994 to 1997 in Brittany, a limited area of France. All charts of patients were reviewed from the diagnosis to the last clinic visit in 2015. Disabling CD course was defined according to the Saint-Antoine criteria.
Among the 331 incident cases of CD, 272 (82%) were followed-up for a median time of 12.8 years. The cumulative probability of developing stricturing or fistulizing CD was 66% at 15 years, and 107 (39%) patients underwent surgery. The cumulative probabilities of immunosuppressant and TNF antagonist use at 15 years were 37% and 22%, respectively. The cumulative risks for disabling disease and bowel damage were 74% and 71% at 15 years, respectively. Systemic symptoms and perianal lesions at diagnosis were independently associated with a disabling disease course. Perianal disease and short disease extension were associated with the onset of bowel damage. Deep ulcers was not predictive of any outcome.
A disabling disease course and bowel damage occurred early in the course of CD, which suggests the need for early diagnosis and early treatment, particularly for patients with systematic symptoms and perianal disease.
An upgraded version of the tidal solutions (FES94.1) is presented, obtained by assimilating an altimeter‐derived data set in the finite element hydrodynamic model, following the representer approach. ...The assimilated data are drawn from the CSR2.0 Texas solutions sampled on a 5° × 5° grid. The assimilation is applied over the Atlantic, Indian, and Pacific Oceans. The standard release of the new FES95.2 solutions is a 0.5° × 0.5° gridded version of the full finite element solutions. The associated tidal prediction model includes 26 constituents. The eight major constituents are drawn directly from the hydrodynamic model: K1, O1, Q1, M2, S2, N2, K2, and 2N2, corrected by assimilation except K2 and 2N2. The other 18 constituents are derived by admittance. Among them are μ2, ν2, L2, T2, M1, P1, J1, and OO1. The quality of these solutions is evaluated by reference to a standard sea truth data set of 95 stations. This quality is significantly improved after the assimilation process is applied: the root‐sum‐square (RSS) of the differences between solutions and observations, for the eight major constituents, is reduced from 3.8 cm for FES94.1 to 2.8 cm for FES95.2, i.e., a gain of 1 cm. The performances of the prediction model are evaluated by comparing tidal predictions with observations at 59 sites distributed over the world ocean and by looking at the level of variance of the sea surface variability observed by the T/P altimeter at its cross‐over track points after tidal correction. These evaluations lead to the same conclusion: this new prediction model performs much better than the one based on FES94.1, because of correction of the major constituents by T/P data assimilation and because of the increase in the number of constituents from 13 to 26. The tidal predictions are at the level of accuracy of those produced by the best recent T/P empirical models.
Abstract
Objectives
In most African countries, confirmed COVID-19 case counts underestimate the number of new SARS-CoV-2 infection cases. We propose a multiplying factor to approximate the number of ...biologically probable new infections from the number of confirmed cases.
Methods
Each of the first thousand suspect (or alert) cases recorded in South Kivu (DRC) between 29 March and 29 November 2020 underwent a RT-PCR test and an IgM and IgG serology. A latent class model and a Bayesian inference method were used to estimate (i) the incidence proportion of SARS-CoV-2 infection using RT-PCR and IgM test results, (ii) the prevalence using RT-PCR, IgM and IgG test results; and, (iii) the multiplying factor (ratio of the incidence proportion on the proportion of confirmed –RT-PCR+– cases).
Results
Among 933 alert cases with complete data, 218 (23%) were RT-PCR+; 434 (47%) IgM+; 464 (~ 50%) RT-PCR+, IgM+, or both; and 647 (69%) either IgG + or IgM+. The incidence proportion of SARS-CoV-2 infection was estimated at 58% (95% credibility interval: 51.8–64), its prevalence at 72.83% (65.68–77.89), and the multiplying factor at 2.42 (1.95–3.01).
Conclusions
In monitoring the pandemic dynamics, the number of biologically probable cases is also useful. The multiplying factor helps approximating it.
Background
The goal of this study was to assess the impact of prone positioning on the incidence of ventilator-associated pneumonia (VAP) and the role of VAP in mortality in a recent multicenter ...trial performed on patients with severe ARDS.
Methods
An ancillary study of a prospective multicenter randomized controlled trial on early prone positioning in patients with severe ARDS. In suspected cases of VAP the diagnosis was based on positive quantitative cultures of bronchoalveolar lavage fluid or tracheal aspirate at the 10
4
and 10
7
CFU/ml thresholds, respectively. The VAP cases were then subject to central, independent adjudication. The cumulative probabilities of VAP were estimated in each position group using the Aalen–Johansen estimator and compared using Gray’s test. A univariate and a multivariate Cox model was performed to assess the impact of VAP, used as a time-dependent covariate for mortality hazard during the ICU stay.
Results
In the supine and prone position groups, the incidence rate for VAP was 1.18 (0.86–1.60) and 1.54 (1.15–2.02) per 100 days of invasive mechanical ventilation (
p
= 0.10), respectively. The cumulative probability of VAP at 90 days was estimated at 46.5 % (27–66) in the prone group and at 33.5 % (23–44) in the supine group. The difference between the two cumulative probability curves was not statistically significant (
p
= 0.11). In the univariate Cox model, VAP was associated with an increase in the mortality rate during the ICU stay HR 1.65 (1.05–2.61),
p
= 0.03. HR increased to 2.2 (1.39–3.52) (
p
< 0.001) after adjustment for position group, age, SOFA score, McCabe score, and immunodeficiency.
Conclusions
In severe ARDS patients prone positioning did not reduce the incidence of VAP and VAP was associated with higher mortality.
Plasma-creatinine-based equations to estimate the glomerular filtration rate are recommended by several clinical guidelines. In 2009, Schwartz et al. adapted the traditional Schwartz equation to ...children and adolescents but did not find different k-coefficients between children and adolescents (k = 36.5 for all patients). We reevaluated the coefficient of the 2009-Schwartz formula according to sex and age in a pediatric population.
We used linear mixed-effects models to reestimate the 2009-Schwartz k-coefficient in 360 consecutive French subjects aged 1 to 18 years referred to a single centre between July 2003 and July 2010 (965 measurements). We assessed the agreement between the estimated glomerular filtration rate obtained with the new formula (called Schwartz-Lyon) and the rate measured by inulin clearance. We then compared this agreement to the one between the measured glomerular filtration rate and 2009-Schwartz formula, first in the French then in a Swedish cohort.
In Schwartz-Lyon formula, k was estimated at 32.5 in boys <13 years and all girls and at 36.5 in boys aged ≥13 years. The performance of this formula was higher than that of 2009-Schwartz formula in children <13 years. This was first supported by a statistically significant reduction of the overestimation of the measured glomerular filtration rate in both cohorts, by better 10% and 30% accuracies, and by a better concordance correlation coefficient.
The performance and simplicity of Schwartz formula are strong arguments for its routine use in children and adolescents. The specific coefficient for children aged <13 years further improves this performance.
Aim To assess topographical and magnetic resonance imaging (MRI) features in characterizing prostate transitional zone (TZ) nodules. Materials and methods Two radiologists evaluated all TZ nodules ...visible at multiparametric MRI in 52 consecutive patients who underwent radical prostatectomy. The radiologists assessed topographical (anteroposterior and superior–inferior location, crossing of the sagittal midline) and T2-weighted (shape, presence and distinctness of capsule, distinctness of contours, presence of cysts) features, the apparent diffusion coefficient (ADC), and eight semi-quantitative and quantitative enhancement parameters derived from dynamic contrast-enhanced (DCE) imaging. The nature of the nodules was assessed using prostatectomy specimens. Five statistical methods taking into account multiple testing were used. Results One hundred and thirty-seven nodules (117 benign, 20 malignant) were evaluated. Mean ADC, all topographical, and all T2-weighted features were significant predictors of malignancy according to at least four out of the five statistical methods. Particularly, 20/20 and 18/20 cancers involved the anterior and apical third of the TZ, respectively. None of the enhancement parameters was significantly different between cancers and benign nodules. By assessing the presence of cysts, the nodules' capsule, and their anteroposterior and superior–inferior location, 111/117 benign nodules were correctly diagnosed, without misclassifying any cancer. Conclusion Topographical, T2-weighted, and diffusion-weighted features can be used to characterize TZ nodules. DCE imaging does not seem to provide additional information.
During septic shock, vasopressors are a cornerstone of therapy. In septic shock, very high doses of vasopressors sometimes have to be used due to vascular desensitization, the mechanisms of which are ...poorly understood. This study assesses whether α-2 agonists increase pressor responsiveness following lipopolysaccharide administration.
Parallel groups of animals (n = 7 per group) subjected to pharmacologic interventions.
Physiology laboratory.
Rats.
In anesthetized rats, the pressor responses to increasing doses of norepinephrine (norepinephrine-systolic pressure curve) were assessed during a baseline period, after injection of saline or lipopolysaccharide, and after subsequent injection of saline, dexmedetomidine (100 μg/kg IV), or clonidine (200 μg/kg IV).
Differences in the slopes of the norepinephrine-pressure curves were assessed across drug treatments and intervals. The pressor dose of norepinephrine necessary to increase systolic pressure by 33 and 100 mm Hg (pressor dose 33 and pressor dose 100) was determined. Pressor responsiveness to norepinephrine decreased slightly over time in the saline-saline group (saline 1 or 2 vs baseline: mean decrease of the slope, 2 mm Hg/μg/kg norepinephrine; p < 0.05), whereas there was a large decrease after lipopolysaccharide (lipopolysaccharide vs baseline: mean decrease of the slope, 7.2; p < 0.001). Clonidine alone had no effect, but when administered following lipopolysaccharide, it caused a striking increase in pressor responsiveness (mean slope after lipopolysaccharide, 10.7 95% CI, 9.9-11.6; after clonidine, 17.5 95% CI, 16.7-18.4). Similarly, dexmedetomidine administered after lipopolysaccharide caused a large increase in pressor responsiveness above lipopolysaccharide values. Accordingly the pressor dose 33 and pressor dose 100 values were lowered following lipopolysaccharide and restored by α-2 agonists.
The pressor response to norepinephrine was reduced following lipopolysaccharide and increased to baseline levels following α-2 agonists.
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