Empyema and lung abscess as complication of a perforated appendicitis in a pregnant woman

INTRODUCTIONThe development of empyema as a result of an intra-abdominal pathology is a rare condition.PRESENTATION OF CASEWe present a 31-year-old woman at 28 weeks’ gestation who was referred to our hospital with diagnosis of pneumonia with pleural effusion. She presented with signs of septicemia and fetal distress. A thoracic-abdominal-pelvic CT-scan showed a right pleural effusion with a retroperitoneal collection in contact with the pleural space. Due to her critical condition, immediate surgical exploration and pregnancy interruption was decided. The fetus was delivered by cesarean with satisfactory vitality. After abdominal exploration, a retrocecal appendicular abscess was evidenced and appendectomy was performed. Subsequently, the right chest was accessed through a posterolateral thoracotomy. An empyema with lung abscess and purulent fluid accessing from the retroperitoneum at the posterior pleural space was found. Due to parenchymal compromise, a right inferior lobectomy was performed. The patient had an uneventful recovery and was discharged at postoperative day 10.DISCUSSIONA septic condition in a pregnant patient with significant thoraco-abdominal infection requires an aggressive approach, with interruption of pregnancy and urgent exploration of the chest and abdomen.CONCLUSIONWhen an empyema is developed in absence of lung disease or other intrathoracic cause, intra-abdominal origin should be considered.     

First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry

AIMS: Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD. METHODS AND RESULTS: We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm. CONCLUSIONS: First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ～2 years. Nearly 50% of FIT could have been prevented by improving device programming.     

Estrogen receptor alpha as a key target of organochlorines to promote angiogenesis

Epidemiological studies report that exposure to pesticides like chlordecone and lindane increases risk of cancer. They may act as endocrine disruptors via the activation of estrogen receptor α (ERα). Carcinogenesis involved angiogenesis and no available data regarding these organochlorines have been reported. The present study aimed at investigating the effects of lindane and chlordecone on cellular processes leading to angiogenesis through an involvement of ERα. Angiogenesis has been analyzed both in vitro, on human endothelial cells, and in vivo by quantifying neovascularization with the use of ECMgel^? plug in mice. Both pesticides increased endothelial cell proliferation, migration and MMP2 activity. These toxics potentiated cell adhesion by enhancing FAK phosphorylation and stress fibers. The two organochlorines increased nitric oxide production via an enhancement of eNOS activity without modification of oxidative stress. Evidence has been provided that the two toxins increased in vivo neovascularization. Most interestingly, all the above processes were either partially or completely prevented after silencing of ERα. Altogether, these data highlight that organochlorines modulate cellular angiogenic processes through activation of ERα. This study further reinforces the harmful effects of these pesticides in carcinogenesis, particularly in the modulation of angiogenesis, a critical step in tumor promotion, through ERα.     

Does the Improvement of Position Sense Following Motor Imagery Practice Vary as a Function of Age and Time of Day?

ABSTRACT

The effectiveness of motor imagery practice is known to depend on age and on the ability to form motor images. In the same individual, motor imagery quality changes during the day, being better late in the morning for older adults and in the afternoon for younger adults. Does this mean that motor imagery practice should be done at specific time of the day depending on the age of participants to maximize motor learning? To examine whether the effect of motor imagery practice varies as a function of time of day and age, the authors used an arm configuration reproduction task and measured position sense accuracy before and after 135 kinesthetic motor imagery trials. Younger and older participants were randomly assigned to either a morning or an afternoon session. Data showed that the accuracy for reproducing arm configurations improved following imagery practice regardless of time of day for both younger and older adults. Moreover, the authors observed that the position sense was less accurate in the afternoon than in the morning in older participants (before and after motor imagery practice), while performance did not change during the day in younger participants. These results may have practical implications in motor learning and functional rehabilitation programs. They highlight the effectiveness of motor imagery practice for movement accuracy in both younger and older adults regardless of time of day. By contrast, they reveal that the assessment of position sense requires that the time of day be taken into account when practitioners want to report on the older patients’ progress without making any mistakes.     

Probing the transient dark state of substrate binding to GroEL by relaxation-based solution NMR

The mechanism whereby the prototypical chaperonin GroEL performs work on substrate proteins has not yet been fully elucidated, hindered by lack of detailed structural and dynamic information on the bound substrate. Previous investigations have produced conflicting reports on the state of GroEL-bound polypeptides, largely due to the transient and dynamic nature of these complexes. Here, we present a unique approach, based on combined analysis of four complementary relaxation-based NMR experiments, to probe directly the “dark” NMR-invisible state of the model, intrinsically disordered, polypeptide amyloid β (Aβ40) bound to GroEL. The four NMR experiments, lifetime line-broadening, dark-state exchange saturation transfer, relaxation dispersion, and small exchange-induced chemical shifts, are dependent in different ways on the overall exchange rates and populations of the free and bound states of the substrate, as well as on residue-specific dynamics and structure within the bound state as reported by transverse magnetization relaxation rates and backbone chemical shifts, respectively. Global fitting of all the NMR data shows that the complex is transient with a lifetime of <1 ms, that binding involves two predominantly hydrophobic segments corresponding to predicted GroEL consensus binding sequences, and that the structure of the bound polypeptide remains intrinsically and dynamically disordered with minimal changes in secondary structure propensity relative to the free state. Our results establish a unique method to observe NMR-invisible dynamic states of GroEL-bound substrates and to describe at atomic resolution the events between substrate binding and encapsulation that are crucial for understanding the normal and stress-related metabolic function of chaperonins.     

Polyunsaturated Fatty Acids and Disease-associated and Cytokine-induced Neurological Manifestations

Fish oil supplementation is suggested as possible mean to improve neurological manifestations of chronic diseases and cytokine immunotherapies. Preclinical and clinical studies show that fish oil supplementation seems able to reduce disease-associated anorexia and body weight loss. This improvement could be due to shifts in metabolism and changes in proinflammatory cytokine production and action. ω-3 Polyunsaturated fatty acids (PUFAs), especially eicosapentaenoic acid, are used as substrates for eicosanoid synthesis, competing for enzymes with arachidonic acid, which is a substrate for the synthesis of proinflammatory immunomodulators, such as prostaglandin E₂. Fish oil supplementation is generally found to lower production of cytokines including interleukin-1 and tumor necrosis factor-α, thereby reducing various immune responses, including inflammation. However, conflicting results regarding the effects of fish oil interventions have been reported. The main factor that emerges from the contradictory reports is the variety of models, assays and methodologies that have been used. This brief review presents an overall perspective on the potential use of ω-3 PUFAs as a nutritional intervention to ameliorate disease-associated and cytokine-induced neurological manifestations. We conclude that substantial further research is required to understand the exact nature of n-3 PUFA-induced immunomodulation in health and disease.