A quality improvement program to improve nutritional status of children with Cystic Fibrosis aged 2-12 years old over a 3 year period at CF center Roscoff,Brittany

Background

The Cystic Fibrosis (CF) center in Roscoff (Brittany) has been involved in therapeutic education programs (TEP) since 2006 and took part in the pilot phase of the French quality improvement program (QIP) since 2011. The aim was to improve the nutritional status of children with cystic fibrosis aged 2-12 years old in order to optimize their health status as they enter adolescence.

Methods

A multidisciplinary quality team was created in order to select and address a specific health problem among our pediatric population. Following analysis of yearly indicators for our CF center, our team chose to improve quality of care concerning nutritional status of children aged 2-12 years old. Factors influencing efficacy were studied, tools were developed to implement a new nutritional program, results were analyzed on a real-time basis.

Results

Over the 3 year period, all patients from 2 years of age, were monitored with the new follow-up program (2012: N =?34; 2014: N =?44). Each patient was followed up at every clinic visit, their BMI z-score was calculated to decide their nutritional risk and personalize their follow-up program consequently. Between 1/1/2012 and 31/12/2014, the mean BMI z-score of the open cohort improved from ?0.49 to ?0.22.

Conclusions

Since 2014, focus on nutrition using the newly-adapted program has become routine practice at each follow-up visit. Patients and parents expressed a high level of satisfaction (75% very satisfied). The follow-up program aimed at improving nutritional status for children aged 2-12 years old was successfully implemented and integrated into routine practice; it was therefore extended to all children with CF (1 month - 18 years) in our center. The relationship among professional and patients and parents was strengthened.

     

The PML and PML/RARα Domains: From Autoimmunity to Molecular Oncology and from Retinoic Acid to Arsenic

Acute promyelocytic leukemia (APL) is specifically associated to a t(15; 17) translocation which fuses a gene encoding a nuclear receptor for retinoic acid, RARα, to a previously unknown gene PML. The PML protein is localized in the nucleus on a specific domain of unknown function (PML nuclear bodies, NB) previously detected with autoimmune sera from patients with primary biliary cirrhosis (PBC). These bodies are nuclear matrix-associated and all of their identified components (PML, Sp100, and NDP52) are sharply upregulated by interferons. We show that autoantibodies against both PML and Sp100 are usually associated in sera with multiple nuclear dot anti-nuclear antibodies and demonstrate that PML is an autoantigen, not only in PBC, but also in other autoimmune diseases. In APL, the PML/RARα fusion interferes with both the retinoic acid (RA) response and PML localization on nuclear bodies, but the respective contribution of each defect to leukemogenesis is unclear. RA induces the terminal differentiation of APL blasts, yielding to complete remissions, and corrects the localization of NB antigens. Arsenic trioxide (As₂O₃) also induces remissions in APL, seemingly through induction of apoptosis. We show that in APL, As₂O₃leads to the rapid reformation of PML bodies. Thus, both agents correct the defect in NB antigen localization, stressing the role of nuclear bodies in the pathogenesis of APL.     

Polynuclear copper(II) complexes with μ2-1,1-azide bridges. Structural and magnetic properties

Two novel, weakly antiferromagnetically coupled, tetranuclear copper(II) complexes [Cu₄(PAP)₂(μ₂-1,1-N₃)₂(μ₂-1,3-N₃)₂(μ₂-CH₃OH)₂(N₃)₄ (1) (PAP = 1,4-bis-(2′-pyridylamino)phthalazine) and [Cu₄(PAP3Me)₂ (μ₂-1,1-N₃)₂(μ₂-1,3-N₃)₂(H₂O)₂(NO₂)₂]- (NO₃)₂ (2) (PAP3Me = 1,4-bis-(3′-methyl-2′-pyridyl)aminophthalazine) contain a unique structural with two μ₂-1,1-azide intramolecular bridges, and two μ₂-1,3-azide intermolecular bridges linking pairs of copper(II) centers. Four terminal azide groups complete the five-coordinate structures in 1, while two terminal waters and two nitrates complete the coordination spheres in 2. The dinuclear complexes [Cu₂(PPD)(μ₂-1,1-N₃)(N₃)₂(CF₃SO₃)]CH₃OH) (3) and [Cu₂(PPD)(μ₂-1,1-N₃)(N₃)₂(H₂O)(ClO₄)] (4) (PPD = 3,6-bis-(1′-pyrazolyl)pyridazine) contain pairs of copper centers with intramolecular μ₂-1,1-azid and pyridazine bridges, and exhibit strong antiferromagnetic coupling. A one-dimensional chain structure in 3 occurs through intermolecular μ₂-1,1-azide bridging interactions. Intramolecular Cu-N₃-Cu bridge angles in 1 and 2 are small (107.9 and 109.4°, respectively), but very large in 3 and 4 (122.5 and 123.2°, respectively), in keeping with the magnetic properties. 2 crystallizes in the monoclinic system, space group C2/c with a = 26.71(1), b = 13.51(3), c = 16.84(1) Å, β = 117.35(3)° and R = 0.070, R_w = 0.050. 3 crystallizes in the monoclinic system, space group P2₁/c with a = 8.42(1), b = 20.808(9), c = 12.615(4) Å, β = 102.95(5)° and R = 0.045, R_w = 0.039. 4crystallizes in the triclinic system, space group P1, with a = 10.253(3), b = 12.338(5), c = 8.072(4) Å, = 100.65(4), β = 101.93(3), γ = 87.82(3)° and R = 0.038, R_w = 0.036 . The magnetic properties of 1 and 2 indicate the presence of weak net antiferromagnetic exchange, as indicated by the presence of a low temperature maximum in χ_m (80 K (1), 65 K (2)), but the data do not fit the Bleaney-Bowers equation unless the exchange integral is treated as a temperature dependent term. A similar situation has been observed for other related compounds, and various approaches to the problem will be discussed. Magnetically 3 and 4 are well described by the Bleaney-Bowers equation, exhibiting very strong antiferromagnetic exchange (− 2J = 768(24) cm⁻¹ (3); − 2J = 829(11) cm⁻¹ (4)).     

Development of two PCR assays for the identification of mycoplasmas causing contagious agalactia

Abstract A new detection test for the mycoplasmas causing contagious agalactia, Mycoplasma agalactiae , M. capricolum subsp. capricolum and M. mycoides subsp. mycoldes L.C., was developed. It was based on two polymerase chain reaction assays: the Ma-PCR for the detection of M. agalactiae and the MYC-PCR for the 'mycoides cluster' thus including M. capricolum subsp. capricolum and M. mycoides subsp. mycoides L.C. An M. agalactiae strain was identified by a 933-bp Ma-PCR product and no amplification with the MYC-PCR. In contrast, a 460-bp MYC-PCR product and a negative or a 350-bp Ma-PCR product characterized a 'mycoides cluster' strain. M. capricolum subsp. capricolum and M. mycoides subsp. mycoides L.C. were identified by their species-specific Asel pattern of the 460-bp MYC-PCR product.     

α-tocopherol,ascorbic acid,and rutin inhibit synergistically the copper-promoted LDL oxidation and the cytotoxicity of oxidized LDL to cultured endothelial cells

Low-density lipoproteins (LDL) mildly oxidized by copper ions or UV radiations exhibit a cytotoxic effect to cultured endothelial cells. Rutin, a polyphenolic flavonoid, ascorbic acid, and α-tocopherol were able to inhibit the peroxidation of LDL and their subsequent cytotoxicity. The mixture of the three compounds (rutin/ascorbic acid/α-tocopherol, 4/4/1) exhibited a supra-additive antioxidant effect. The inhibition of the cytotoxic effect was well correlated with that of TBARS formation. Another important conclusion is that these antioxidants were able to prevent directly at the cellular level the cytotoxic effect of oxidized LDL, since cells preincubated with them were protected against the cytotoxic effect of previously oxidized LDL. The protective effect of antioxidants was limited because of their own toxicity. The antioxidant mixture permitted a maximal cytoprotective effect with relatively lower concentrations to be obtained and the cytotoxicity of high concentrations to be avoided. In conclusion, rutin, ascorbic acid, and α-tocopherol constitute two lines of defense in protecting cells against injury owing to oxidation of LDL (1) at the LDL level, by inhibiting the LDL oxidation and the subsequent cytotoxicity, and (2) at the cellular level, by protecting the cells directly, i.e., by increasing their resistance against the cytotoxic effect of oxidized LDL.     

A fedbatch strategy for optimal red pigment production by monascus ruber

According to the measurement of the pigment production and some material balance treatments, the monosodium glutamate (MSG), which represents a main substrate involved in the production of red pigment by Monascus ruber, is recovered on-line. Fedbatch operation then represents an alternative for increasing the production of pigment. A nonlinear quotient control scheme is expressed to regulate the monosodium glutamate substrate at an optimal value determined from batch studies.List of Symbols A absorbancy units (AU) - L lightness parameter - Pig red pigment quantity (Gmol) - vol fermentor active volume (1) - empirical coefficient - MW _pig red pigment molecular weight (g) - E elementary matrix - E ^# pseudo-inverse elementary matrix - r conversion rates vector (g· l^–1·h^–1) - E _m measured part of the elementary matrix - r _m measured conversion rates vector - E _c non-measured part of the elementary matrix - r _c non-measured conversion rates vector - v fictitious controller input - h fictitious controller output - u controller input - y controller output - y controller setpoint - k ₁ controller parameter - k ₂ controller parameter - k time iteration - MSG monosodium glutamate concentration (g·l^–1) - MSG _init monosodium glutamate initial quantity (g) - MSG _added total quantity of monosodium glutamate added (g) - MSG _cons total quantity of monosodium glutamate consumed (g) - MW _msg monosodium glutamate molecular weight (g)     

THE SYMMETRY OF CORRELATED SELECTION RESPONSES IN ADAPTIVE EVOLUTION: AN EXPERIMENTAL STUDY USING DROSOPHILA

The relationship between the processes of density-dependent and age-specific selection has been investigated by examining a common phenotype, urea resistance, which has apparently evolved in response to each of these selection mechanisms. Twenty populations that have experienced differing levels of age-specific selection show differences in egg-to-adult viability in environments with high levels of urea. Among this group of populations, it appears that resistance to urea is correlated with longevity, but not development time. Ten populations kept at extreme larval densities for many generations also show responses to urea: those kept at high larval densities appear to be most resistant to urea. However, these populations show no differences in adult longevity. An additional five populations were selected directly for urea resistance by adding this compound to the larval food environment. Again, there was a strong response to this artificial selection, with urea resistance increasing dramatically, but these populations showed no response in adult longevity or resistance to crowding when compared to five control populations. There is clearly no simple relationship between longevity and larval urea resistance. It may be that age-specific and density-dependent selection induce similar changes in this phenotype, but do so through different genetic and physiological pathways. We suggest that these data are not consistent with the view of constant and symmetric genetic variance-covariance matrices. These data support a more prominent role for observations of evolutionary trajectories rather than static measurements of genetic components of variance.     

DENSITY-DEPENDENT NATURAL SELECTION IN DROSOPHILA: EVOLUTION OF GROWTH RATE AND BODY SIZE

Drosophila melanogaster populations subjected to extreme larval crowding (CU lines) in our laboratory have evolved higher larval feeding rates than their corresponding controls (UU lines). It has been suggested that this genetically based behavior may involve an energetic cost, which precludes natural selection in a density-regulated population to simultaneously maximize food acquisition and food conversion into biomass. If true, this stands against some basic predictions of the general theory of density-dependent natural selection. Here we investigate the evolutionary consequences of density-dependent natural selection on growth rate and body size in D. melanogaster. The CU populations showed a higher growth rate during the postcritical period of larval life than UU populations, but the sustained differences in weight did not translate into the adult stage. The simplest explanation for these findings (that natural selection in a crowded larval environment favors a faster food acquisition for the individual to attain the same final body size in a shorter period of time) was tested and rejected by looking at the larva-to-adult development times. Larvae of CU populations starved for different periods of time develop into comparatively smaller adults, suggesting that food seeking behavior in a food depleted environment carries a higher cost to these larvae than to their UU counterparts. The results have important implications for understanding the evolution of body size in natural populations of Drosophila, and stand against some widespread beliefs that body size may represent a compromise between the conflicting effects of genetic variation in larval and adult performance.