bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination of a fillet flap, free tissue transfer, and autologous tissue grafts in pelvic reconstruction following retroperitoneal sarcoma: A case report
Authors: Saksena Anshuman , Aho Johnathon , Winocour Sebastian , Maricevich Renata , Senchenkov Alex , Rose Peter , Leibovich Bradley , Zietlow Scott , Saint‐Cyr Michel
Published: November 2014

The resection of large pelvic tumors is challenging due to their infiltrative nature into multiple structures and organ systems. In this report, we describe the use of multiple vascularized and nonvascularized spare parts to reconstruct a pelvic defect in a patient with a uniquely large pelvic sarcoma invading the spinal canal. A 39‐year‐old Caucasian female who presented with a large retroperitoneal sarcoma where the tumor encased the left ureter, kidney, colon, and external iliac vessels and invaded the L3‐S1 vertebral bodies. An extensive hemipelvectomy and reconstruction was performed over two days. A free thigh and leg fillet flap together with ipsilateral fibula flap, based on the superficial femoral artery and venae comitantes, was used for spinal reinforcement as well as abdominal and pelvic wall reconstruction. The postoperative course was uneventful without complications, no flap compromise or wound healing problems. After a follow‐up period of 4 months, the patient had no complications and returned to activities of daily living with mild limitations. The success of this flap procedure shows the practicality and usefulness of using the full spectrum of tissue transfer for the purposes of a large pelvic reconstruction. © 2014 Wiley Periodicals, Inc. Microsurgery 35:320–323, 2015.
The role of non‐enhanced angiography in toe tip transfer with small diameter pedicle
Authors: Yoshimatsu Hidehiko , Yamamoto Takumi , Iwamoto Taku , Hayashi Akitatsu , Narushima Mitsunaga , Iida Takuya , Koshima Isao
Published: November 2014

Background

Toe tip transfer allows functional and esthetic reconstruction of the lost fingertip, but it is still uncommon because identification and dissection of donor and recipient veins can be challenging. Nonenhanced angiography (NEA) is a device that emits infrared light at a wavelength of 850 nm, which is exclusively absorbed by hemoglobin. The light penetrates the bones and other soft tissues, effectively visualizing veins in real time. The aim of this report is to present the experience on the preoperative use of nonenhanced angiography for visualization of donor and recipient veins in toe tip transfers in a series of patients.

Patients and Methods

Four cases of toe tip transfer and one case of free nail flap were performed for reconstruction of the tips of thumb and finger with preoperative examination using NEA. Patients' age ranged from 29 to 52 years old (average, 29.2 years old). Before the operation, the veins in the donor and recipient sites were marked using NEA, and the blood flow of the veins in the recipient site was confirmed.

Results

Pedicles in all transferred toe tips were less than 2 cm in length, with diameters smaller than 0.8 mm. The postoperative courses were uneventful, and all transferred toe tips survived completely, with satisfying functional and aesthetic results.

Conclusions

NEA may facilitate venous dissection of the donor and the recipient sites, allowing safe and efficient toe tip transfer with a small pedicle. © 2014 Wiley Periodicals, Inc. Microsurgery 35:364–369, 2015.
Fiber consumption and all‐cause, cardiovascular, and cancer mortalities: A systematic review and meta‐analysis of cohort studies
Authors: Liu Lihua , Wang Shan , Liu Jianchao
Published: November 2014

The present meta‐analysis aimed to investigate fiber consumption and all‐cause mortality, and cause‐specific mortality. MEDLINE and web of science database were searched for cohort studies published from inception to August 2014. Studies were included if they provided a hazard ratio (HR) and corresponding 95% CI for mortality in relation to fiber consumption.We found that, compared with those who consumed lowest fiber, for individuals who ate highest fiber, mortality rate was lower by 23% (HR, 0.77; 95% CI, 0.72–0.81) for CVD, by 17% (HR, 0.83; 95% CI, 0.74–0.91) for cancer, by 23% (HR, 0.77; 95% CI, 0.73–0.81) for all‐cause mortality. For each 10 g/day increase in fiber intake, the pooled HR was estimated to be 0.89 (95% CI, 0.86–0.93) for all‐cause mortality, 0.80 (95% CI, 0.72–0.88) for CHD mortality, and 0.66 (95% CI, 0.40–0.92) for IHD mortality, 0.91 (95% CI, 0.88–0.94) for cancer. Dietary fiber and CVD mortality showed a strong dose–response relation. Apparently, fiber consumption is inversely associated with all‐cause mortality and CVD, IHD, cancer mortality.
Apolipoprotein E (APOE) genotype regulates body weight and fatty acid utilization—Studies in gene‐targeted replacement mice
Authors: Huebbe Patricia , Dose Janina , Schloesser Anke , Campbell Graeme , Glüer Claus‐Christian , Gupta Yask , Ibrahim Saleh , Minihane Anne‐Marie , Baines John F. , Nebel Almut , Rimbach Gerald
Published: November 2014

Scope

Of the three human apolipoprotein E (APOE) alleles, the ε3 allele is most common, which may be a result of adaptive evolution. In this study, we investigated whether the APOE genotype affects body weight and energy metabolism through regulation of fatty acid utilization.

Methods and results

Targeted replacement mice expressing the human APOE3 were significantly heavier on low‐ and high‐fat diets compared to APOE4 mice. Particularly on high‐fat feeding, food intake and dietary energy yields as well as fat mass were increased in APOE3 mice. Fatty acid mobilization determined as activation of adipose tissue lipase and fasting plasma nonesterified fatty acid levels were significantly lower in APOE3 than APOE4 mice. APOE4 mice, in contrast, exhibited higher expression of proteins involved in fatty acid oxidation in skeletal muscle.

Conclusion

Our data suggest that APOE3 is associated with the potential to more efficiently harvest dietary energy and to deposit fat in adipose tissue, while APOE4 carriers tend to increase fatty acid mobilization and utilization as fuel substrates especially under high‐fat intake. The different handling of dietary energy may have contributed to the evolution and worldwide distribution of the ε3 allele.
Axonal excitability in primary amyloidotic neuropathy
Authors: Hafner Jessica , Ghaoui Roula , Coyle Luke , Burke David , Ng Karl
Published: November 2014

Introduction: Acquired and hereditary amyloidosis can cause peripheral neuropathy, but the mechanisms by which this occurs have not been established. Threshold tracking techniques allow in vivo assessment of the properties of the axonal membrane and may shed light on pathogenetic mechanisms underlying neuropathic disorders. Methods: We studied 10 subjects with primary amyloidosis using conventional nerve conduction studies and quantitative sensory, autonomic, and axonal excitability testing of median motor and sensory fibers. Results: As expected, subjects with amyloidosis had evidence of small‐ and large‐fiber neuropathy on conventional testing. There was no significant difference in axonal excitability between subjects and controls apart from the stimulus required to activate sensory fibers. Conclusions: Amyloid‐related neuropathy does not produce a change in membrane potential as either a primary or secondary event. This suggests that ischemia and axonal compression are unlikely mechanisms for the neuropathy. Muscle Nerve 51: 443–445, 2015
Sporadic late‐onset nemaline myopathy as a rare cause of slowly progressive muscle weakness with young adult onset
Authors: Maeda Meiko Hashimoto , Ohta Hikari , Izutsu Koji , Shimizu Jun , Uesaka Yoshikazu
Published: November 2014

Introduction: Sporadic late‐onset nemaline myopathy (SLONM) is a rare intractable acquired myopathy characterized by progressive muscle weakness and atrophy, usually with middle to late adult onset. Autologous peripheral blood stem cell transplantation (auto‐PBSCT) has been reported to be a promising treatment for SLONM. Methods: In this study we performed clinical characterization, muscle histopathological analysis, and muscle power monitoring after auto‐PBSCT in a 27‐year‐old HIV‐negative man with monoclonal gammopathy. Results: He showed improved muscle strength after treatment with high‐dose melphalan and auto‐PBSCT. Conclusions: Considering the recent reports of successful treatment of SLONM, early and correct diagnosis of this condition in association with monoclonal gammopathy is important. SLONM should be added to the list of diseases to consider in the differential diagnosis of progressive muscle weakness with young adult onset. Muscle Nerve 51:772–774, 2015
Evaluation of material point method for use in geotechnics
Authors: Sołowski W. T. , Sloan S. W.
Published: November 2014

The first part of the paper presents a material point method solution for the bearing capacity of a deep foundation in purely cohesive soil, which is a widely known engineering problem. The results computed with the generalised interpolation material point method are compared to the results obtained previously with an advanced limit analysis code. The second part of the paper shows material point method simulations of collapsing piles of granular material and compares the results with experimental observations from the literature. The problems considered are problematic to solve using the displacement finite element method as they generally include very large deformations. Copyright © 2014 John Wiley & Sons, Ltd.
Bicriteria multiresource generalized assignment problem
Authors: Karsu Özlem , Azizoğlu Meral
Published: November 2014

In this study, we consider a bicriteria multiresource generalized assignment problem. Our criteria are the total assignment load and maximum assignment load over all agents. We aim to generate all nondominated objective vectors and the corresponding efficient solutions. We propose several lower and upper bounds and use them in our optimization and heuristic algorithms. The computational results have shown the satisfactory behaviors of our approaches. © 2014 Wiley Periodicals, Inc. Naval Research Logistics, 61: 621–636, 2014
Bevacizumab for symptomatic radiation‐induced tumor enlargement in pediatric low grade gliomas
Authors: Foster Kimberly A. , Ares William J. , Pollack Ian F. , Jakacki Regina I.
Published: November 2014

Background

Radiation therapy (RT)‐induced effects in children treated for low grade glioma (LGG) can result in worsening of neurologic symptoms and clinical and radiographic deterioration. Treatment for radiation‐induced tumor enlargement is based on symptom control and usually involves steroids.

Procedure

We conducted a retrospective review of children with LGG treated with RT who developed symptomatic radiation‐induced tumor enlargement and were managed with bevacizumab. Charts were abstracted for onset and duration of RT changes, toxicity and doses of dexamethasone and bevacizumab. Tumor volumes prior to RT, at maximal size following RT, after bevacizumab administration, and at follow‐up were evaluated.

Results

Five children were treated with bevacizumab for symptomatic radiation‐induced tumor enlargement following RT for LGG at a median of 4.2 months (range, 1–11 months) after completion of RT. The median increase in volume of tumor was 195.4% (range, 115.5–309%) compared to the pre‐RT volume. Bevacizumab 5–10 mg/kg was administered IV q 2–4 weeks as primary treatment (n = 1) or to assist in weaning patients off steroids (n = 4). All children on high dose steroids (n = 4) were weaned off or to physiologic doses of hydrocortisone. Two children developed avascular necrosis after prolonged steroid use and while on bevacizumab. Radiographically, all children showed significant improvement and are now a median of 31 months (range, 18–50 months) from the completion of radiation without requiring additional tumor‐related therapy.

Conclusions

Bevacizumab can play an important role in children with symptomatic radiation changes following LGG treatment, allowing patients to avoid or minimize the toxicity of long‐term steroid use. Pediatr Blood Cancer 2015;62:240–245. © 2014 Wiley Periodicals, Inc.
Comparison of pain outcomes between two anti‐GD2 antibodies in patients with neuroblastoma
Authors: Anghelescu Doralina L. , Goldberg Jacob L. , Faughnan Lane G. , Wu Jianrong , Mao Shenghua , Furman Wayne L. , Santana Victor M. , Navid Fariba
Published: November 2014

Background

Addition of anti‐GD2 antibody ch14.18 to the treatment of neuroblastoma has improved outcomes. The most common side effect of ch14.18 is neuropathic pain, which may in part be complement‐mediated. Hu14.18K322A is a humanized anti‐GD2 antibody designed to diminish complement activation and induce less pain. We compare the pain outcomes in patients treated with ch14.18 and those treated with hu14.18K322A, and explore dose‐dependent relationships between pain scores, opioid requirements, and complement levels in patients treated with hu14.18K322A.

Procedure

Opioid (morphine equivalent mg/kg) and anxiolytic requirements during course 1 (4 days) in patients treated with hu14.18K322A and ch14.18 were reviewed. Correlations between antibody dose and pain scores, opioid requirements, and complement levels were examined for patients receiving hu14.18K322A.

Results

Patients treated with hu14.18K322A (n = 19) had lower opioid requirements than those who received ch14.18 (n = 9). The differences in median opioid requirements (mg/kg) were statistically significant for the overall course (1.57 vs. 2.41, P = 0.019) as well as for Days 3 (0.34 vs. 0.65, P = 0.005), and 4 (0.32 vs. 0.64, P = 0.010). No difference in anxiolytic use was observed between the two groups. In the group treated with hu14.18K322A, we found a positive correlation between antibody dose administered and pain scores, but no correlation between antibody dose and opioid requirements or changes in complement levels.

Conclusions

In this retrospective analysis, hu14.18K322A induced less pain than ch14.18 based on opioid requirements. Pediatr Blood Cancer 2015;62:224–228. © 2014 Wiley Periodicals, Inc.
Fanconi anemia and solid malignancies in childhood: A national retrospective study
Authors: Malric Aurore , Defachelles Anne‐Sophie , Leblanc Thierry , Lescoeur Brigitte , Lacour Brigitte , Peuchmaur Michel , Maurage Claude‐Alain , Pierron Gaëlle , Guillemot Delphine , d'Enghien Catherine Dubois , Soulier Jean , Stoppa‐Lyonnet Dominique , Bourdeaut Franck
Published: November 2014

Background

Fanconi anemia (FA) predisposes to hematologic disorders and myeloid neoplasia in childhood and to solid cancers, mainly oral carcinomas, in early adulthood. Few cases of solid cancers have been reported in childhood.

Procedures

We conducted a national retrospective study of solid tumors occurring in patients registered with or determined to have FA during childhood in France. Phenotypic features, tumor type, cancer treatment, and outcome were analyzed. Whenever available, fresh‐frozen tumors were analyzed by microarray‐based comparative genomics hybridization.

Results

We identified eight patients with FA with solid tumor from 1986 to 2012. For two patients, the diagnosis of FA was unknown at the time of cancer diagnosis. Moreover, we identified one fetus with a brain tumor. All patients showed failure to thrive and had dysmorphic features and abnormal skin pigmentation. Seven patients had BRCA2/FANCD1 mutations; five of these featured more than one malignancy and the median age at the time of cancer diagnosis was 11 months (range 0.4–3 years). Solid tumor types included five nephroblastomas, two rhabdomyosarcomas, two neuroblastomas, and three brain tumors. Two children died from the toxic effects of chemotherapy, two patients from the cancer, and one patient from secondary leukemia. Only one BRCA2 patient was alive more than 3 years after diagnosis, after tailored chemotherapy.

Conclusion

Solid tumors are rare in FA during childhood, except in patients with BRCA2/FANCD1 mutations. The proper genetic diagnosis is mandatory to tailor the treatment. Pediatr Blood Cancer 2015;62:463–470. © 2014 Wiley Periodicals, Inc.
Implementation of transcranial Doppler ultrasonography screening and primary stroke prevention in urban and rural sickle cell disease populations
Authors: Hussain Samiya , Nichols Fenwick , Bowman Latanya , Xu Hongyan , Neunert Cindy
Published: November 2014

Background

Transcranial Doppler (TCD) ultrasonography identifies children with sickle cell disease (SCD) at increased risk of stroke. Initiation of chronic transfusions as primary stroke prevention in children with abnormal TCD significantly reduces stroke risk. Here, we report the results describing the implementation of TCD screening and primary stroke prevention in both urban and rural clinical practices.

Procedure

Retrospective chart review identified children ages 2–16 years with Hgb SS or Sß0‐thalassemia and no history of stroke followed in either the local urban or rural SCD clinics at Georgia Regents University. We defined standard of care (SOC) as having one TCD performed annually between January 2010 and December 2012 starting at age 2 years.

Results

A total of 195 patients were included in the evaluation of SOC screening, overall 41% achieved SOC. There was no difference in SOC between the two clinics (35% urban and 47.4% rural). The majority of patients with abnormal TCDs are on chronic transfusions (83%), and none have experienced a stroke. Monitoring of effects of transfusion was difficult with 38% and 31% of rural patients lacking documentation of Hgb S% and ferritin levels, respectively, in the past year.

Conclusions

We report here data describing primary stroke prophylaxis in rural patients. SOC rates are similar between the two clinical settings. While implementation of primary stroke prevention in rural patients was difficult, rural TCD screening is feasible and can achieve SOC equal to that in an urban setting. This suggests that barriers exist in provided primary stroke prevention to all patients. Pediatr Blood Cancer 2015;62:219–223. © 2014 Wiley Periodicals, Inc.
Influence of bony resection margins and surgicopathological factors on outcomes in limb‐sparing surgery for extremity osteosarcoma
Authors: Loh Amos H.P. , Wu Huiyun , Bahrami Armita , Navid Fariba , McCarville M. Beth , Wang Chong , Wu Jianrong , Bishop Michael W. , Daw Najat C. , Neel Michael D. , Rao Bhaskar N.
Published: November 2014

Background

Limb‐sparing surgery for osteosarcoma requires taking wide bony resection margins while maximizing preservation of native bone and joint. However, the optimal bony margin and factors associated with recurrence and survival outcomes in these patients are not well established.

Procedure

We conducted a retrospective review of outcomes in children and adolescents with newly diagnosed osteosarcoma from 1986 to 2012, where bony resection margins for limb‐sparing surgeries were decreased serially from 5 to 1.5 cm. The association between bony margins and other surgicopathological factors with survival and recurrence outcomes was determined.

Results

In 181 limb‐sparing surgeries in 173 patients, planned and actual bony resection margins were not significantly associated with local recurrence‐free survival (LRFS), event‐free survival (EFS), and overall survival (OS)—at median 5.8 years follow‐up, decreasing planned bony resection margins from 5 to 1.5 cm did not significantly decrease survival outcomes. Multivariable analysis showed that the presence of distant metastases at diagnosis was associated with decreased LRFS, EFS, and OS (P = 0.002, 0.005, and <0.0001, respectively). Post‐chemotherapy tumor necrosis ≤90% was associated with decreased EFS and OS (P = 0.001 and 0.022, respectively). Earlier years of treatment and pathologic fractures were associated with decreased OS only (P = 0.018 and 0.008, respectively); previous cancer history and male gender were associated with decreased EFS only (P = 0.043 and 0.023, respectively).

Conclusion

We did not observe significant increase in adverse survival outcomes with reduction of longitudinal bony resection margins to 1.5 cm. Established prognostic factors, particularly histologic response to chemotherapy and metastases at diagnosis, remain relevant in limb‐sparing patients. Pediatr Blood Cancer 2015;62:246–251. © 2014 Wiley Periodicals, Inc.
Incidence and clinical presentation of primary hemophagocytic lymphohistiocytosis in Sweden
Authors: Meeths Marie , Horne AnnaCarin , Sabel Magnus , Bryceson Yenan T. , Henter Jan‐Inge
Published: November 2014

Background

Primary hemophagocytic lymphohistiocytosis (HLH) represents a group of inherited hyperinflammatory immunodeficiencies, including familial HLH (FHL), Griscelli syndrome type 2 (GS2), and X‐linked lymphoproliferative syndrome (XLP). We previously reported an annual incidence of suspected primary HLH in Sweden 1971–1986 of 0.12 per 100,000 children. Here, we determined if the incidence had increased with concomitant awareness.

Procedure

Children <15 years old presenting with HLH 1987–2006 in Sweden were identified through the national mortality registry as well as by nation‐wide inquiries to all pediatric centers. HLH was diagnosed according to the HLH‐2004 diagnostic guidelines (in case of missing data of at least three of the eight diagnostic criteria, fulfillment of four was sufficient for inclusion). We defined primary HLH as patients presenting with HLH requiring transplantation or dying of disease.

Results

Remarkably, the minimal annual incidence rate of primary HLH remained 0.12 per 100,000 children, equating to 1.8 per 100,000 live births. Notably, an increased overall survival was observed in 1997–2006, relative to the period 1987–1996. During the subsequent 5‐year period, 2007–2011, the incidence of genetically and/or functionally verified primary HLH was 0.15 per 100,000 children per year, suggesting that new assays may aid the identification of patients with primary HLH.

Conclusion

The annual incidence of primary HLH in Sweden is 0.12–0.15 per 100,000 children per year. Pediatr Blood Cancer 2015;62:346–352. © 2014 Wiley Periodicals, Inc.
A novel trial of topotecan, ifosfamide, and carboplatin (TIC) in children with recurrent solid tumors
Authors: Radhakrishnan Kavita , Lee Alice , Harrison Lauren A. , Morris Erin , Shen Violet , Gates Laura , Wells Robert J. , Wolff Johannes E. , Garvin James H. , Cairo Mitchell S.
Published: November 2014

Background

Ifosfamide, carboplatin, and etoposide (ICE) in children with refractory or recurrent solid tumors and lymphomas has resulted in good overall response rates (ORR). Etoposide, a topoisomerase‐II inhibitor, however, has been associated with a significant increase in secondary leukemia. The rationale for substituting topotecan, a topoisomerase‐I inhibitor, for etoposide in this regimen, a topoisomerase‐II inhibitor, includes its limited toxicity profile and decreased leukemogenicity. Furthermore, topotecan in combination with both alkylators and platinating agents are additive and/or synergistic against a variety of solid tumors.

Procedure

Patients with relapsed/refractory solid tumors received ifosfamide (9 g/m2) and carboplatin (area under the curve: 3 mg/ml/min). Topotecan was also administered at 0.5 mg/m2/day × 3 days (N = 12) and in a small cohort (N = 3) at 0.75 mg/m2/day.

Results

Fifteen patients were entered onto study. Two patients developed seizures/encephalitis secondary to ifosfamide. One patient had dose‐limiting thrombocytopenia secondary to TIC that resolved with supportive care. Patients received a median of three cycles (1–3) of TIC. Of the 14 evaluable patients for response, 4/14 had a complete response (CR), 2/14 had a partial response (PR), and 1/14 patients had stable disease (SD). The ORR (CR + PR) was 43%.

Conclusion

TIC chemotherapy is feasible and tolerable in children and adolescents with refractory/recurrent solid tumors and lymphomas and results in a 43% excellent ORR in this poor‐risk group of patients. A larger cohort of patients, especially in Wilms tumor and central nervous system (CNS) tumors, should be studied in the future to attempt to confirm these preliminary findings. Pediatr Blood Cancer 2015;62:274–278. © 2014 Wiley Periodicals, Inc.
Risk factors for abandonment of Wilms tumor therapy in Kenya
Authors: Libes Jaime , Oruko Oliver , Abdallah Fatmah , Githanga Jessie , Ndung'u James , Musimbi Joyce , Njuguna Festus , Patel Kirtika , White John , Axt Jason R. , O'Neill James A. , Shrubsole Martha , Li Ming , Lovvorn Harold N.
Published: November 2014

Background

Survival from Wilms tumor (WT) in sub‐Saharan Africa remains dismal as a result of on‐therapy mortality and treatment abandonment. Review of patients diagnosed from 2008 to 2011 in our Kenyan Wilms Tumor Registry showed a loss to follow up (LTFU) rate approaching 50%. The purpose of this study was to trace those LTFU, estimate the survival rate, and identify risk factors for treatment abandonment.

Procedure

We administered a comprehensive survey to parents of patients with WT at the two largest referral hospitals in Kenya to identify barriers to care. We also telephoned families who had abandoned care to determine vital status and identify risk factors for treatment abandonment.

Results

Of 136 registered patients, 77 were confirmed dead (56.7%), 38 remained alive (27.9%), and the vital status of 21 patients remains unknown (15.4%). After contacting 33 of the patients who either abandoned curative treatment (n = 34) or did not attend off‐therapy visits (n = 20), the best estimate of 2‐year overall survival of patients with WT in Kenya approaches 36%. Sixty‐three percent of parents misunderstood treatment plans and 55% encountered financial barriers. When asked how to increase comfort with the child's treatment, 27% of parents volunteered improving inefficient services and 26% volunteered reducing drug‐unavailability.

Conclusions

Treatment abandonment remains a significant problem contributing to increased mortality from WT in developing countries. This multi‐center survey identified the barriers to treatment completion from the parental perspective to be lack of education about WT and treatment, financial constraints, need for quality improvement, and drug‐unavailability. Pediatr Blood Cancer 2015;62:252–256. © 2014 Wiley Periodicals, Inc.
Cutaneous B‐lymphoblastic lymphoma with IL3/IgH translocation presenting with hypereosinophilia and acute endocarditis
Authors: Bomken Simon , Haigh Shaun , Bown Nick , Carey Peter , Wood Katrina , Windebank Kevin
Published: November 2014

Hypereosinophilia is a rare phenomenon associated with childhood malignancy, predominantly acute lymphoblastic leukaemia. Causation is unclear and likely to have multiple mechanisms. We report a six year old boy presenting with hypereosinophilia and associated Loeffler endocarditis. Three months following his initial hypereosinophilia he developed cutaneous B‐lymphoblastic lymphoma. Re‐analysis of apparently uninvolved bone marrow, taken at initial presentation, revealed a single, previously unidentified, t(5;14)(q31;q32) positive cell. Using fluorescent in situ hybridisation, we demonstrate IL3/IgH@ fusion in cutaneous lymphoma cells. Our case confirms the association of hypereosinophilia and B‐lymphoblastic lymphoma and strengthens the association between IL3 hypersecretion and hypereosinophilia. Pediatr Blood Cancer 2015;62:1055–1057. © 2014 Wiley Periodicals, Inc.
Homopolymerization and copolymerization of N‐substituted maleimides with chiral anionic initiators
Authors: Huang Yi‐Ling , Cao Jing , Hu Wei , Liang Sai
Published: November 2014

Novel optically
active anionic initiators bearing a chiral oxazole substituent on the fluorene ring, (S)‐1‐(9H‐fluoren‐2‐yl)‐4‐isopropyl‐4,5‐dihydrooxazole lithium (Li‐(S)‐1‐FIDH) and (S)‐2‐(9H‐fluoren‐2‐yl)‐4‐isopropyl‐4,5‐dihydrooxazole lithium (Li‐(S)‐2‐FIDH), were prepared. Anionic homopolymerizations of achiral N‐substituted maleimide (RMI) with the chiral initiators were investigated. The optically active polymers obtained were attributed to asymmetric induction of the chiral initiators. The very crowded chiral initiator Li‐(S)‐1‐FIDH was found to play a better asymmetric induction role in the polymers than Li‐(S)‐2‐FIDH. Anionic copolymerization of (R)‐(+)‐N‐1‐phenylethyl maleimide and optically inactive RMI with Li‐(S)‐1‐FIDH were also studied. © 2014 Society of Chemical Industry
A benzophenone‐naphthalimide derivative as versatile photoinitiator of polymerization under near UV and visible lights
Authors: Zhang Jing , Zivic Nicolas , Dumur Frédéric , Xiao Pu , Graff Bernadette , Gigmes Didier , Fouassier Jean Pierre , Lalevée Jacques
Published: November 2014

A benzophenone‐naphthalimide derivative (BPND) bearing tertiary amine groups has been developed as a high‐performance photoinitiator in combination with 2,4,6‐tris(trichloromethyl)‐1,3,5‐triazine or an iodonium salt for both the free radical polymerization (FRP) of acrylates and the cationic polymerization (CP) of epoxides upon exposure to near UV and visible LEDs (385–470 nm). BPND can even produce radicals without any added hydrogen donor. The photochemical mechanisms are studied by molecular orbital calculations, steady state photolysis, electron spin resonance spin trapping, fluorescence, cyclic voltammetry and laser flash photolysis techniques. These novel BPND based photoinitiating systems exhibit an efficiency higher than that of the well‐known camphorquinone‐based systems (FRP and CP) or comparable to that of bis(2,4,6‐trimethylbenzoyl)‐phenylphosphineoxide (FRP at λ ≤ 455 nm). © 2014 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2015, 53, 445–451
Comparison of monomethoxy‐, dimethoxy‐, and trimethoxysilane anchor groups for surface‐initiated RAFT polymerization from silica surfaces
Authors: Huebner Dennis , Koch Vanessa , Ebeling Bastian , Mechau Jannik , Steinhoff Judith Elisabeth , Vana Philipp
Published: November 2014

The immobilization of reversible addition–fragmentation chain transfer (RAFT) agents on silica for surface‐initiated RAFT polymerizations (SI‐RAFT) via the Z‐group approach was studied systematically in dependence of the functionality of the RAFT‐agent anchor group. Monoalkoxy‐, dialkoxy‐, and trialkoxy silyl ether groups were incorporated into trithiocarbonate‐type RAFT agents and bound to planar silica surfaces as well as to silica nanoparticles. The immobilization efficiency and the structure of the bound RAFT‐agent film varied strongly in dependence of the used solvent (toluene vs. 1,2‐dimethoxyethane) and the anchor group functionality, as evidenced by atomic force microscopy, transmission electron microscopy, dynamic light scattering, and UV/Vis spectroscopy. Surface‐initiated RAFT polymerizations using functionalized silica nanoparticles revealed that grafted oligomers, which often occur in SI‐RAFT, are not formed within the crosslinked structures that originate from the immobilization, and that RAFT‐agent films that show less aggregation during the immobilization are more efficient during SI‐RAFT in terms of polymer grafting density. © 2014 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2015, 53, 103–113
Molecular damage inFabry disease: Characterization and prediction of alpha‐galactosidaseApathological mutations
Authors: Riera Casandra , Lois Sergio , Domínguez Carmen , Fernandez‐Cadenas Israel , Montaner Joan , Rodríguez‐Sureda Victor , de la Cruz Xavier
Published: November 2014

Loss‐of‐function mutations of the enzyme alpha‐galactosidase A (GLA) causes Fabry disease (FD), that is a rare and potentially fatal disease. Identification of these pathological mutations by sequencing is important because it allows an early treatment of the disease. However, before taking any treatment decision, if the mutation identified is unknown, we first need to establish if it is pathological or not. General bioinformatic tools (PolyPhen‐2, SIFT, Condel, etc.) can be used for this purpose, but their performance is still limited. Here we present a new tool, specifically derived for the assessment of GLA mutations. We first compared mutations of this enzyme known to cause FD with neutral sequence variants, using several structure and sequence properties. Then, we used these properties to develop a family of prediction methods adapted to different quality requirements. Trained and tested on a set of known Fabry mutations, our methods have a performance (Matthews correlation: 0.56–0.72) comparable or better than that of the more complex method, Polyphen‐2 (Matthews correlation: 0.61), and better than those of SIFT (Matthews correl.: 0.54) and Condel (Matthews correl.: 0.51). This result is validated in an independent set of 65 pathological mutations, for which our method displayed the best success rate (91.0%, 87.7%, and 73.8%, for our method, PolyPhen‐2 and SIFT, respectively). These data confirmed that our specific approach can effectively contribute to the identification of pathological mutations in GLA, and therefore enhance the use of sequence information in the identification of undiagnosed Fabry patients. Proteins 2015; 83:91–104. © 2014 Wiley Periodicals, Inc.
Using CHETAH to estimate lower flammable limit, minimum ignition energy, and other flammability parameters
Authors: Britton Laurence G. , Harrison Benjamin Keith
Published: November 2014

Britton discovered that with increased “net heat of oxidation” (ΔHox), the maximum flame temperatures of CH and CHO fuels in air increase linearly while flame temperatures at the lower flammable limit (LFL) decrease linearly. Maximum flame temperature is a major factor determining the combustion rate of optimum fuel‐air mixtures and relationships were found between ΔHox and “optimized” flammability parameters such as minimum ignition energy. The LFL is the fuel concentration needed to attain the lower limit flame temperature; since less fuel is needed to attain a smaller flame temperature, the LFL varies inversely with ΔHox. Simple expressions derived between ΔHox and parameters commonly used in process safety were previously published in this journal. The commercially available computer program “CHETAH™” now solves these expressions and outputs the flammability parameters plus the internally generated thermodynamic data used in the solutions. This article updates the original expressions together with new findings and explanatory material. © 2014 American Institute of Chemical Engineers Process Saf Prog 33: 314–328, 2014
Approche motivationnelle auprès des auteurs de violences sexuelles : revue de la littérature et aspects cliniques
Authors: Bertsch I. , Cano J.
Published: November 2014

En France, le suivi sanitaire des sujets condamnés pour des infractions sexuelles en milieu ouvert ambulatoire s’effectue généralement dans le cadre des soins pénalement ordonnés.

Les prises en charge de ces auteurs se heurtent régulièrement à des difficultés diverses comme la question sensible de la formulation de la demande de suivi par les patients a partie de la laquelle émergent les dimensions de volonté de changement et de motivation au traitement. Considérant le modèle motivationnel de Miller et Rollnick [1], il est fréquent de constater que les auteurs de violences sexuelles se situent généralement aux stades de pré-contemplation et de contemplation de leurs difficultés et que les facteurs motivationnels au changement sont surtout extrinsèques.

La motivation étant un phénomène complexe divers facteurs semblent impliqués dans l’amorce du changement. La littérature reconnaît la présence de facteurs sociodémographiques, liés à l’individu et liés à l’environnement.

Parmi les solutions proposées à l’accès au changement la thérapie sous contrainte semble être privilégiée. On attend de celle-ci qu’elle soit le moteur d’une évolution du fonctionnement du patient qui se traduirait par exemple par une modification du discours les faits, la considération de la victime par l’auteur… [2].

L’adaptation des techniques d’entretien motivationnel apporterait des bénéfices dans le suivi de ces patients, en termes d’adaptation aux rythmes individuels, d’engagement et de responsabilisation [3]. Cela proposerait un outil thérapeutique pertinent, et resituerait l’approche motivationnelle dans le mouvement d’approches dites « positives » développées depuis quelques années.

Ce poster se propose d’aborder la question de la motivation au changement des auteurs de violences sexuelles à travers des rappels théoriques de la théorie du changement, des facteurs impliqués dans le changement des AVS et une application clinique de cette méthode du changement.
Place des chronothérapies dans la prise en charge de la dépression résistante : à partir d’un cas clinique
Authors: Tremey A. , Charpeaud T. , Llorca P.-M.
Published: November 2014

Introduction

La prise en charge des épisodes dépressifs caractérisés, se heurte à un taux de réponse à un premier traitement antidépresseur ne dépassant pas 30 à 45 %, et un taux de rémission n’excédant pas 30 % [1]. Devant ce constat, des stratégies thérapeutiques non-pharmacologiques sont légitimement en cours d’étude. C’est le cas par exemple, des chronothérapies, applications d’un modèle chronobiologique de la dépression élaboré dès le début des années 1980 [2].

Objectif

Nous nous sommes intéressés à ce modèle et avons souhaité, à partir d’un exemple clinique, nous interroger sur la place des techniques thérapeutiques qui en découlent dans l’organisation hiérarchique des traitements de la dépression.

Méthode

Nous présentons le cas d’un patient souffrant de dépression unipolaire résistante de stade V [3], présentant à l’admission un score de sévérité côté à 35 sur l’échelle de Montgomery et Asberg. Devant certaines caractéristiques cliniques de l’état dépressif suggérant une « susceptibilité chronobiologique », d’une part, et à la vue de données d’efficacité émanant de la littérature, d’autre part, nous avons décidé d’associer au traitement antidépresseur médicamenteux, un traitement par privation partielle de sommeil et luminothérapie matinale.

Résultats

Au terme de cette prise en charge, nous avons constaté une rémission des symptômes dépressifs, avec un score MADRS de 6 après 5 semaines de traitement, et un maintien de la rémission clinique à 6 mois.

Discussion

L’application et l’efficacité de ces thérapies renvoient à l’hypothèse d’un fondement chronobiologique de la dépression. Leur place dans les recommandations pour la pratique clinique et dans les algorithmes de traitement de la dépression reste limitée. Il n’apparaît pas impossible que le paradigme pharmacologique dominant la psychiatrie puisse en être une des explications [4]. Il s’agit pourtant d’alternatives thérapeutiques simples, dont l’efficacité et la tolérance sont démontrées dans une littérature de plus en plus abondante.
L’impact de l’informel dans le travail infirmier en psychiatrie
Authors: Lanquetin J.-P. , Tchukriel S.
Published: November 2014

Cette recherche en soins vise à identifier, nommer, qualifier et surtout caractériser les fonctions de l’informel dans le soin infirmier en psychiatrie, particulièrement dans l’écart entre soins programmés et soins non programmés. Il s’agit alors d’objectiver les savoirs faire mobilisés, mais aussi leurs impacts et leurs spécificités. Les objectifs de cette recherche en soins infirmiers (RSI) sont mobilisés sur trois niveaux d’investigations : en direction du patient, du professionnel et de l’équipe.

Cette recherche multicentrique a connu sa phase d’enquêtes de terrain auprès d’équipes de soins d’unités d’hospitalisation temps plein de quatre établissements de la région Rhône Alpes, établissements représentatifs de l’offre de soins publique sectorisée. Les enquêtes ont allié trois outils d’investigation : des « entretiens semi-dirigés », des séquences « d’observations participantes périphériques » et des « dialogues en interaction avec l’action ». Le traitement de ces données de terrain a abouti à la détermination de 3100 unités d’actions en lien avec l’informel.

Nous nous appuyons dans nos axes théoriques sur les apports et les invariants structuraux de la psychothérapie institutionnelle, de la psychodynamique du travail ainsi que de la praxéologie. Les résultats se présentent sous une triple forme. Tout d’abord, le cœur de la recherche avec la caractérisation de 139 fonctions en lien avec l’informel dans les soins, puis l’approche quantitative de ces données qualitatives (variable de lieux, de temps, de sites, etc.) et enfin le dégagement d’invariants opératoires, pour les caractéristiques communes à tous les sites investigués.

Cette recherche et ses résultats sont en mesure d’établir sur des données valides, bien des zones invisibles et peu lisibles du travail institutionnel et des savoirs infirmier en psychiatrie. La caractérisation de ces attentions, de ces « micro-actes » et « micro-interventions » concourent à un « prendre soin » individuel et collectif, participent d’un climat relationnel, ouvrent à des espaces transitionnels ou se déploient aussi bien des actions de cognition sociales que les différentes dimensions de la proxémie, de l’empathie et du « care ».
De l’asile à la cité
Authors: Degeilh B. , Bailly G. , Le Guen S. , Poulain S.
Published: November 2014

Contexte et objectifs

Un pôle intersectoriel dédié aux patients dits longs séjours a été créé en 2010 au sein de l’hôpital psychiatrique de Dordogne. Une active politique de réhabilitation psycho-sociale a été élaborée pour les quatre années du contrat de pôle dans lequel s’engageait alors une petite équipe pluridisciplinaire déterminée à désinstitutionnaliser ces patients (30 % des « lits » du centre hospitalier).

Philosophie des soins et moyens engagés

Cure and care, socle de l’empowerment[1]. Des soins spécifiques, notamment la déclinaison originale de l’éducation thérapeutique du patient, la remédiation cognitive et l’apprentissage des habiletés sociales, ont porté un processus de rétablissement [2] ouvrant les portes de l’asile à des personnes hospitalisées depuis des années. Développement des partenariats au-delà des institutions sanitaires et médico-sociales, le soutien d’organismes publics et d’entreprises privées (associations, artisans) a redonné une présence citoyenne à ces malades dénommés chroniques dont la vie s’était longtemps limitée pour l’essentiel à l’enceinte de l’hôpital psychiatrique.

Création d’une association

Notre association ARCHES a animé deux sections. La première, scientifique, a organisé trois colloques sur l’actualité des thérapies proposées dans les troubles psychiatriques chroniques et la déstigmatisation de la maladie mentale. La deuxième a oeuvré à développer la psychiatrie communautaire en soutenant l’installation des patients dans la cité et l’implication de nos partenaires profanes [3].

Résultats et analyse critique

Quinze pour cent de notre patientèle est installée en appartement, 30 % en établissement médico-social. Les limites de nos actions, qui s’inscrivent dans le droit fil des rapports ministériels [4], sont tracées au sein de notre équipe, de notre institution et du contexte socio-économique.

Conclusion

Notre équipe pose une expertise loco-régionale en soins de suite et de réadaptation psychosociale après ses quatre années d’exercice dans un mouvement d’idées et d’actions que certains nomment psychiatrie citoyenne pour que les personnes souffrant de troubles mentaux chroniques réintègrent la vie communautaire autant que faire se peut.
Dispensation nominative automatisée des médicaments en EPSM : évaluation du motif de non administration de son impact coût
Authors: Renaud A. , Wattecamps C. , Blondiaux S. , Moens C. , Zawadzki E.
Published: November 2014

Dans le cadre de la sécurisation du circuit du médicament, l’établissement s’est doté d’un automate de dispensation. Il permet de faire une dispensation journalière individuelle des formes sèches prescrites en systématique. Chaque jour, une bande de sachet par patient est produite (1 sachet = 1 spécialité et 1 horaire). Nous avons évalué la part des traitements non administrés et leur impact économique. Les 16 unités de soins conservent les sachets non administrés. La pharmacie les collecte. Une base de données Excel est incrémentée pendant un mois : nombre de sachets et contenus. Une cause probable de non administration est recherchée via le Pharma. L’outil statistique de l’automate indique le nombre de sachets fabriqués sur la période. Le coût unitaire des médicaments est extrait du logiciel Pharma. Les coûts humain et en consommables ne sont pas traités.

4,12 % des sachets sont rendus, ce qui représente 3,94 % du coût global journalier (16,03 €/j). Les principaux motifs sont les sorties/permissions (47 %), une utilisation de la dotation (19 %), une modification de prescription (15 %) ou la prescription non conditionnelle des hypnotiques et anxiolytique au coucher (14 %). Les classes médicamenteuses retrouvées sont les antipsychotiques (21 %), les anxiolytiques (21 %), les hypnotiques (11 %), les normothymiques (7 %) et les antidépresseurs (5 %). Parmi les autres, on retrouve majoritairement des correcteurs, des médicaments à visée cardiovasculaires et des vitamines. Extrapolés sur un an, le coût des retours représente 0,79 % du budget annuel de la pharmacie. Cette part a pu être partiellement diminuée par :

– une communication efficace et constante avec les services afin d’anticiper les sorties et permissions des patients ;

– la sensibilisation des médecins à prescrire en si besoin les prises du soir ;

– un rappel des horaires de production Bien que l’impact économique soit faible, la sensibilisation de l’ensemble des acteurs doit donc être poursuivie.
EQUIPAD : une expérience innovante de soins psychiatriques intensifs à domicile à Nantes
Authors: Porcheret-Lotz D. , Haddou S. , Lequimener V.
Published: November 2014

EQUIPAD (entourage quotidien par une unité d’intervention de psychiatrie pluridisciplinaire à domicile) est une structure de soins pour des patients en souffrance psychique aiguë qui intervient à domicile.

Les missions

C’est une véritable alternative à l’hospitalisation « classique ». La capacité d’accueil est de 6 places. Les soins dispensés répondent aux critères :

– de coordination des intervenants ;

– de la fréquence des interventions ;

– de pluridisciplinarité ;

– de développement du réseau.

Ils se situent comme une alternative à l’hospitalisation à temps complet en amont ou en aval. Par ailleurs, ces soins peuvent préparer une hospitalisation ou raccourcir une durée d’hospitalisation par des soins à domicile ou être une aide au diagnostic.

Le relais de soins est effectué par le psychiatre traitant adresseur. Si le patient n’en a pas, il sera adressé au centre médico-psychologique ou à un psychiatre libéral afin de poursuivre les soins ambulatoires.

La prise en charge

Ce mode d’hospitalisation s’adresse à tout patient âgé de plus de 18 ans, en souffrance psychique aiguë et résidant sur Nantes centre ville.

L’hospitalisation

La durée maximum d’hospitalisation est de 21 jours, renouvelable une fois. Les patients ne peuvent pas être admis plus de trois fois dans l’année.

Le patient doit être consentant aux soins et vivre dans un environnement salubre. La présence d’un aidant familial comme partenaire de soins est recommandée. Les patients en programme de soins peuvent être admis.

Ce dispositif fonctionne du lundi au vendredi de 8 h 30 à 18 h et les week-ends/jours fériés de 9 h à 16 h 30.

Une infirmière passe entre une à deux fois par jour au domicile. Un à deux entretiens médicaux sont programmés par semaine.

Les équipes soignantes et sociales font aussi un travail de liaison avec les partenaires médicaux, sociaux et infirmiers habituels du patient.