Scintigraphie à l’OctréoScan® : aspects pratiques. Le point de vue du manipulateur

Evaluation of neuroendocrine tumors extent comprises a somatostatin receptor scintigraphy with OctréoScan^®. This examination begins with the radiopharmaceutical preparation and its quality control (dose, visual appearance, radiochemical purity, pH). The radiopharmaceutical is administered intravenously at a slow rate with respect of the contra-indications and recommendations. The patient's good respect of low residue diet and digestive preparations is essential for a good imaging quality. In addition, the technologist's psychological role (particularly for people suffering from claustrophobia) and adequate procedures must be taken into account. Several days are necessary to perform the examination that comprises whole body and planar (thoracic and abdominal) views, combined SPECT-CT imaging. This hybrid modality using fused images allows a good anatomical localisation of focal areas of increased uptake even in case of faint uptake. Some false-positive can be avoided (colonic stasis, gall bladder). SPECT-CT contribution to the diagnosis is certain.     

The effects of extended nap periods on cognitive,physiological and subjective responses under simulated night shift conditions

Extended nap opportunities have been effective in maintaining alertness in the context of extended night shifts (+12?h). However, there is limited evidence of their efficacy during 8-h shifts. Thus, this study explored the effects of extended naps on cognitive, physiological and perceptual responses during four simulated, 8-h night shifts. In a laboratory setting, 32 participants were allocated to one of three conditions. All participants completed four consecutive, 8-h night shifts, with the arrangements differing by condition. The fixed night condition worked from 22h00 to 06h00, while the nap early group worked from 20h00 to 08h00 and napped between 00h00 and 03h20. The nap late group worked from 00h00 to 12h00 and napped between 04h00 and 07h20. Nap length was limited to 3 hours and 20 minutes. Participants performed a simple beading task during each shift, while also completing six to eight test batteries roughly every 2?h. During each shift, six test batteries were completed, in which the following measures were taken. Performance indicators included beading output, eye accommodation time, choice reaction time, visual vigilance, simple reaction time, processing speed and object recognition, working memory, motor response time and tracking performance. Physiological measures included heart rate and tympanic temperature, whereas subjective sleepiness and reported sleep length and quality while outside the laboratory constituted the self reported measures. Both naps reduced subjective sleepiness but did not alter the circadian and homeostatic-related changes in cognitive and physiological measures, relative to the fixed night condition. Additionally, there was evidence of sleep inertia following each nap, which resulted in transient reductions in certain perceptual cognitive performance measures. The present study suggested that there were some benefits associated with including an extended nap during 8-h night shifts. However, the effects of sleep inertia need to be effectively managed to ensure that post-nap alertness and performance is maintained.     

Diurnal and Seasonal Variations in Chlorophyll a Fluorescence in Two Mediterranean-Grassland Species Under Field Conditions

Seasonal and daily variations in chlorophyll (Chl) fluorescence were studied in two representative species of Mediterranean grasslands, Tuberaria guttata (an annual) and Chamaemelum nobile (a perennial), in order to assess physiological responses to climatically induced stresses during the growing season. The photochemical efficiency of photosystem (PS) 2 in dark-adapted leaves was measured by the Chl fluorescence ratio Fv/Fp. This ratio decreased progressively from December to July, as the effects of increasing solar radiation and summer drought became more severe. The seasonal decline was observed particularly as a depression of morning and midday values, when photoinhibition was more evident. In both species, the extent of this diurnal depression increased with midday irradiance throughout winter and spring. After sunset, there was complete recovery to optimum values. Towards the end of the life cycle, increased irradiance did not affect the midday decline further but Fv/Fp measurements in the morning and evening never regained their optimum values, indicating the accumulation of photodamage in the reaction centres of PS2. The half-rise time of Fp (T1/2), used to estimate the size of the plastoquinone pool, showed little daily variation in C. nobile throughout the most important part of its seasonal cycle. However, towards the end of its life cycle (June and July) T1/2 values ranged from ca. 200 ms before sunrise to near zero at midday on the same day. The annual species, T. guttata, showed similar disregulation in energy transmission rate both at the seedling stage and at end of its life cycle. Thus seedlings and reproductive plants in particular are sensitive to environmental conditions (extremes of temperature and drought) and cannot maintain consistent electron flow throughout the day.     

Horizontal transmission of Symbiodinium cells between adult and juvenile corals is aided by benthic sediment

Of all reef-building coral species, 80–85 % initially draw their intracellular symbionts (dinoflagellates of the genus Symbiodinium) from the environment. Although Symbiodinium cells are crucial for the growth of corals and the formation of coral reefs, little is known about how corals first encounter free-living Symbiodinium cells. We report how the supply of free-living Symbiodinium cells to the benthos by adult corals can increase the rate of horizontal symbiont acquisition for conspecific recruits. Three species of newly settled aposymbiotic (i.e., symbiont-free) corals were maintained in an open aquarium system containing: sterilized sediment and adult coral fragments combined; adult coral fragments alone; sterilized sediment alone; or seawater at Heron Island, Great Barrier Reef, Australia. In all instances, the combination of an adult coral and sediment resulted in the highest symbiont acquisition rates by juvenile corals (up to five-fold greater than seawater alone). Juvenile corals exposed to individual treatments of adult coral or sediment produced an intermediate acquisition response (<52 % of recruits), and symbiont acquisition from unfiltered seawater was comparatively low (<20 % of recruits). Additionally, benthic free-living Symbiodinium cells reached their highest densities in the adult coral + sediment treatment (up to 1.2 × 10⁴ cells mL⁻¹). Our results suggest that corals seed microhabitats with free-living Symbiodinium cells suitable for many coral species during the process of coral recruitment.

     

Stentless Versus Stented Bioprosthetic Aortic Valves: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2008

OBJECTIVE:: The purpose of this consensus conference was to determine whether stentless bioprosthetic valves improve clinical and resource outcomes compared with stented valves in patients undergoing aortic valve replacement, and to outline evidence-based recommendations for the use of stentless and stented bioprosthetic valves in adult aortic valve replacement. METHODS:: Before the consensus conference, the best available evidence was reviewed in that systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. At the consensus conference, evidence-based statements were created, and consensus processes were used to determine the ensuing recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of recommendation. RESULTS AND RECOMMENDATIONS:: Seventeen randomized studies published in 23 articles involving 1317 patients, and 14 nonrandomized trial published in 18 articles involving 2485 patients were included in the meta-analysis and consensus conference. All randomized trials inserted the stentless bioprosthetic valves in the subcoronary configuration. The consensus panel agreed upon the following statements and recommendations in patients undergoing aortic valve replacement:Because there were no randomized control trial comparing subcoronary stentless prosthetic valve and root replacement, the following recommendations are derived from expert opinion:     

Human cord blood CD4+CD25hi regulatory T cells suppress prenatally acquired T cell responses to Plasmodium falciparum antigens

In malaria endemic regions, a fetus is often exposed in utero to Plasmodium falciparum blood-stage Ags. In some newborns, this can result in the induction of immune suppression. We have previously shown these modulated immune responses to persist postnatally, with a subsequent increase in a child's susceptibility to infection. To test the hypothesis that this immune suppression is partially mediated by malaria-specific regulatory T cells (T(regs)) in utero, cord blood mononuclear cells (CBMC) were obtained from 44 Kenyan newborns of women with and without malaria at delivery. CD4(+)CD25(lo) T cells and CD4(+)CD25(hi) FOXP3(+) cells (T(regs)) were enriched from CBMC. T(reg) frequency and HLA-DR expression on T(regs) were significantly greater for Kenyan as compared with North American CBMC (p < 0.01). CBMC/CD4(+) T cells cultured with P. falciparum blood-stage Ags induced production of IFN-γ, IL-13, IL-10, and/or IL-5 in 50% of samples. Partial depletion of CD25(hi) cells augmented the Ag-driven IFN-γ production in 69% of subjects with malaria-specific responses and revealed additional Ag-reactive lymphocytes in previously unresponsive individuals (n = 3). Addition of T(regs) to CD4(+)CD25(lo) cells suppressed spontaneous and malaria Ag-driven production of IFN-γ in a dose-dependent fashion, until production was completely inhibited in most subjects. In contrast, T(regs) only partially suppressed malaria-induced Th2 cytokines. IL-10 or TGF-β did not mediate this suppression. Thus, prenatal exposure to malaria blood-stage Ags induces T(regs) that primarily suppress Th1-type recall responses to P. falciparum blood-stage Ags. Persistence of these T(regs) postnatally could modify a child's susceptibility to malaria infection and disease.