Is a prophylactic treatment by erythropoietin relevant to reduce red blood cell transfusion in the pediatric intensive care unit?

OBJECTIVE: An adult trial reported the efficacy of recombinant human erythropoietin in critically ill patients with a 19% decrease in red blood cell transfusion. Our aim was to evaluate the relevance of this prophylactic treatment in children hospitalized in a pediatric intensive care unit (PICU). DESIGN: Cohort study from January 1995 to December 2004. SETTING: University hospital PICU. PATIENTS: Children between 1 month and 18 yrs of age. INTERVENTIONS: We searched through a prospective databank for all children hospitalized in the PICU for > or =4 days (potential recipients of erythropoietin, as proposed in the adult trial) and transfused with red blood cells after day 7 following PICU entry (in whom erythropoietin might prevent anemia, according to results of the adult trial). MEASUREMENTS AND MAIN RESULTS: We found that 799 of 2,578 children (31%) were hospitalized for > or =4 days. The study group comprised 787 patients who were hospitalized for > or =4 days in the PICU and for whom full records were available. One hundred eighty-three children in this study group were transfused during their stay in the PICU (median age, 7 months; weight, 6.60 kg). Hemoglobin levels before transfusion (mean +/- sd) were 7.7 +/- 1.5 g/dL. These transfused children represented 23% of the study group and 7% of the total PICU admissions. Forty-seven children (6% of the study group, 2% of the total PICU admissions) were transfused with red blood cells after 7 days of hospitalization and could have benefited from a prophylactic treatment with erythropoietin. Relative risk to benefit of a prophylactic treatment by erythropoietin was higher in cases of mechanical ventilation (relative risk, 1.18) and inotropic treatment (relative risk, 1.72) and if the main diagnosis involved dermatological (relative risk, 3.03) or oncologic disease (relative risk, 3.94). CONCLUSIONS: If we applied the results of the adult trial to our PICU, we would have to treat 31% of the children with prophylactic erythropoietin and thereby expect a reduction of one red blood cell transfusion for every 17 treated patients.     

Light and temperature influence on diuron bioaccumulation and toxicity in biofilms

Ecotoxicology - Variations of temperature and photoperiod throughout different seasons can affect aquatic communities such as biofilms. Biofilms, generally present at the base of trophic chains in...     

Favorable radiological outcome of skeletal Erdheim-Chester disease involvement with anakinra

Erdheim-Chester disease is a rare non-langerhans cell histiocytosis characterized by infiltration of foamy CD68-positive but CD1a-negative macrophages and fibro-inflammatory lesions as retroperitoneal, periureteral areas or bones. Interferon-α therapy has been used as treatment but it had variable efficiency and limited tolerance. More recently, a recombinant form of interleukin-1 receptor antagonist (anakinra) was used with success but no skeletal radiological improvement was recorded. We report here a case of interleukin-1 receptor antagonist in the treatment of refractory bones infiltration in Erdheim-Chester disease. After 1 year of treatment, the positron emission tomography-computed tomography showed an outstanding response of the skeletal involvement with clearly lower and smaller hypermetabolism images.     

Modulation of muscarinic facilitation of epileptiform discharges in immature rat neocortex

We examined the cholinergic effects on epileptiform discharge generation in immature (postnatal days 10-20) rat neocortex. Evoked and spontaneous field potentials were recorded from the deep layers of neocortical slices during GABA(A) receptor blockade by bicuculline methiodide (BMI, 50 microM). The anticholinesterase eserine (10 microM) as well as the ACh-analog carbamylcholine chloride (CCh, 25 microM) decreased the amplitude and duration of evoked field potentials and in parallel, increased significantly the rate of occurrence of spontaneous discharges. These effects were reversed by the muscarinic antagonist atropine (2.5 microM, n = 20), but not by the nicotinic receptor antagonist hexamethonium (50 microM, n = 3). The M1 subtype-selective muscarinic antagonist pirenzepine (1 microM, n = 12) blocked spontaneous discharges in 8/12 slices, while muscarinic antagonists of the M2 (AFDX 116 n = 4), M3 (4-DAMP n = 4) and M4 (gallamine n = 5, tropicamide n = 6) type, all at 1 microM, only reduced their frequency. CCh-induced spontaneous discharges were blocked by the combination of the glutamate receptor antagonists AP5 and CNQX (both at 10 microM; n = 11). Gap junction blockers abolished them (halothane, n = 7) or reduced their frequency by 65% (carbenoxolone, n = 8). Inhibiting Ca2+ release from intracellular stores by dantrolene (100 microM, n = 5) or thapsigargin (1 microM, n = 5) also depressed their frequencies by 55-65%. By contrast, their rates were not altered by perfusion with high Ca2+ (7 mM; n = 6) medium, a manipulation suppressing polysynaptic connections. These findings demonstrate that activation of muscarinic receptors, notably of the M1 type, in immature rat neocortex facilitates the generation of glutamatergic epileptiform discharges. These discharges are strongly inhibited by gap junction blockers, and are also partly mediated by the, presumably muscarinic receptor-dependent, mobilization of intracellular calcium.     

Use of polar organic chemical integrative samplers to assess the effects of chronic pesticide exposure on biofilms

The responses of aquatic organisms to chronic exposure to environmental concentrations of toxicants, often found in mixtures, are poorly documented. Here passive sampler extracts were used in experimental contamination of laboratory channels, to investigate their effects on natural biofilm communities. A realistic mixture of pesticides extracted from Polar Organic Chemical Integrative Samplers was used to expose biofilms in laboratory channels to total pesticide concentrations averaging 0.5 ± 0.1 μg l^?1. The level of exposure was representative of field conditions in terms of relative proportions of the substances but the exposure concentration was not maintained (decreasing concentrations between contamination occasions). The impact on the structural as well as the functional characteristics of the autotrophic and heterotrophic components was determined, using biofilm grown in uncontaminated conditions (reference site) and in sites exposed to pesticides (contaminated site). The exposure imposed did not significantly modify the structure or functions of reference biofilms, nor did it modify tolerance as measured by mixture EC₅₀ (EC₅₀ mix). In contrast, the communities from the more contaminated downstream section lost tolerance following decreased dose exposure, but community composition remained fairly stable. Overall, these results indicate that low levels of contamination did not lead to strong changes in community structure, and 14-day changes in tolerance seemed to depend mainly on physiological adaptation, suggesting that other environmental factors or longer-lasting processes prevailed. This study reports the first attempt to use passive sampler extracts as a realistic composite contaminant for experimental exposure of biofilms, with promising perspectives in further ecotoxicology studies.     

Live 3D echocardiography with the pediatric matrix probe

Three-dimensional echocardiography (3DE) enables new views of heart valves and the septa to be imaged. While the previous 3DE system was cumbersome, the recent introduction of live 3DE allowed for routine use of the technique in adult patients. Here, we report our initial experiences in adapting live 3DE and the adult matrix probe to the pediatric population. Thirty-four 3DE examinations were performed on children, aged 1 day to 12 years (n = 23; median 4 years) and fetuses 20-33 weeks in gestation (n = 11; median 25 weeks), many of whom had various congenital heart diseases. The pediatric matrix probe (2-7 MHz) was used for 2D, Doppler, and 3DE. New modalities of the Vision 2007 (Philips) were applied: live, full volume, thick slice, 3D color Doppler, the QLAB system for navigation, and cropping. The pediatric matrix probe allows for complete 2D and 3D echocardiography, and new acoustic windows are now available to perform live 3DE. The higher frequency of the probe increases the 3D image resolution obtained in neonates and fetuses. This advancement allows new views of the aorta, pulmonary valve, septa and intra cardiac anatomy to be captured. Real time 3DE is a feasible method in addition to conventional 2D echocardiography for evaluating congenital heart disease.