Surveillance of hemolytic uremic syndrome in children less than 15 years of age, a system to monitor O157 and non-O157 Shiga toxin-producing Escherichia coli infections in France, 1996-2006

BACKGROUND: Since the 1980s, Shiga toxin-producing Escherichia coli (STEC), especially E. coli O157:H7, has been an important cause of food borne disease in industrial countries. In France, as there was no routine screening for STEC in clinical laboratories, enhanced surveillance of hemolytic uremic syndrome (HUS) in children less than 15 years of age was established in 1996 to monitor trends in the incidence of STEC infections. METHODS: The surveillance system was based on a voluntary national network of pediatricians of 31 pediatric nephrology units in public hospitals. RESULTS: From 1996 to 2006, the mean annual incidence of HUS was 0.71 cases per 100,000 children less than 15 years of age and 1.87 cases per 100,000 children less than 5 years of age. STEC infections were confirmed in 66% of patients; STEC O157 was the most common serogroup identified in STEC-related HUS (83%). In this 11-year period, 96% of HUS cases were sporadic and only 2 outbreaks caused by STEC O157 and by a dual infection of STEC O26 and O80 were detected. CONCLUSIONS: An evaluation of the surveillance of pediatric HUS showed that it is a simple and useful system for monitoring trends in STEC infections in France. It provides the information needed to measure the impact of new and changing vehicles of STEC transmission, and evaluate the effectiveness of prevention measures.     

Promotion of cholangiocarcinoma growth by diverse cancer-associated fibroblast subpopulations

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Elders of 75 and over at an emergency service

Context: Elderly patients represent an important and growing part of the emergency department activity. Purpose: To describe population aged of 75?and over admitted in an emergency department without programming and then compare patients addressed with a letter of referral or not. Methods: A prospective transversal study was carried out over one month in the emergency department of the hospital of Macon. It concerned all patients aged of 75?and over admitted at the emergency department. Results: The study concerned 459?passages of elders (17% of admissions during the period), among whom 40% were addressed with a letter of referral. Mean age was 83.4, with a sex-ratio of 0.6. The hospitalization rate is significantly higher among the letter addressed group: 84% vs 72% (p<0.01). The Emergency room reception of elderly people was evaluated as required for 70% of cases (essentially for medical reasons) and the family physician could have planed the hospitalization for 21% of cases. The mean duration stay was 8.6?days. The mortality at one month was 6%, without significant difference between the two groups. Readmission rate after 3?months was of 20% one more time at least during the period. Discussion: Elderly people passage through the emergency department tends to become the admission way to the hospital. An important part of these patients are addressed with a letter of referral, which does not modify the patient's orientation. Nevertheless, some could avoid emergency room passage. This report has to bring us to a reflexion about a work with the physicians to welcome in best these elders at hospital.     

The effects of peridural anesthesia on duration of labor and mode of delivery]

OBJECTIVE: To determine the effect of epidural analgesia (EA) on the duration of labour and the mode of delivery. DATA SOURCES: A Medline computerised literature research was conducted from 1989 to 2000 including all the prospective studies comparing EA and systemic analgesia during labour. DATA SYNTHESIS: EA prolongs the first and second stages of labour and increases the rate of instrumental delivery, without neonatal side effects. EA is not responsible for dystocia and caesarean section rate is not increased by this mode of analgesia. The effect of combined spinal-epidural analgesia is comparable to the one of EA on the length of labour and the mode of delivery. Ropivacaine does not appear to be different from bupivacaine in that setting. The benefit of ambulation remains controversial since it does not reduce the incidence of instrumental delivery, compared to conventional EA with similarly diluted local anaesthetic solutions. CONCLUSIONS: Pain relief provided by EA combined to modification of obstetric management (amniotomy, oxytocin) does not impair the rate of caesarean section and dystocia.     

Knockin mice expressing fluorescent delta-opioid receptors uncover G protein-coupled receptor dynamics in vivo

The combination of fluorescent genetically encoded proteins with mouse engineering provides a fascinating means to study dynamic biological processes in mammals. At present, green fluorescent protein (GFP) mice were mainly developed to study gene expression patterns or cell morphology and migration. Here we used enhanced GFP (EGFP) to achieve functional imaging of a G protein-coupled receptor (GPCR) in vivo. We created mice where the delta-opioid receptor (DOR) is replaced by an active DOR-EGFP fusion. Confocal imaging revealed detailed receptor neuroanatomy throughout the nervous system of knock-in mice. Real-time imaging in primary neurons allowed dynamic visualization of drug-induced receptor trafficking. In DOR-EGFP animals, drug treatment triggered receptor endocytosis that correlated with the behavioral response. Mice with internalized receptors were insensitive to subsequent agonist administration, providing evidence that receptor sequestration limits drug efficacy in vivo. Direct receptor visualization in mice is a unique approach to receptor biology and drug design.