Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.

Acute Myocardial Infarction: Mode of Revelation of a Left Atrium Myxoma

True, cardiac myxoma is a benign tumor. On the other hand, it is serious by its complications, in particular embolic. The diagnosis of acute coronary syndrome in connection with a myxoma of the left atrium is retained before the association of an emboligenic intracardiac myxoma and an acute coronary syndrome in the absence of atherosclerotic lesions and the absence of intracardiac thrombus. We report a case of left atrium myxoma complicated by acute coronary syndrome in a 50-year-old patient operated on in our department and we will review the literature.

Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis

AIM: To determine whether the association of β-blockers with endoscopic treatment is superior to endoscopic treatment alone for the secondary prophylaxis of oesophageal variceal bleeding. METHODS: Randomised controlled trials comparing sclerotherapy (SCL) with SCL plus β-blockers (BB) or banding ligation (BL) with BL plus BB were identif ied.Main outcomes were overall and 6, 12 and 24 mo rebleeding rates, as well as overall and 6, 12 and 24 mo mortality. Two statistical methods were used: Yusuf-Peto, and Der Simonian and Laird. Inter-trial heterogeneity was systematically taken into account. RESULTS: Seventeen randomised controlled trials were included, 14 with SCL and 3 with BL. Combination β-blocker and endoscopic treatment signif icantly reduced rebleeding rates at 6, 12 and 24 mo and overall [odds ratio (OR): 2.20, 95% conf idence interval (CI): 1.69-2.85, P<0.0001] compared to endoscopic treatment alone. Mortality at 24 mo was signif icantly lower for the combined treatment group (OR: 1.83, 95% CI:1.16-2.90, P= 0.009), as well as overall mortality (OR: 1.43, 95% CI:1.03-1.98, P= 0.03). CONCLUSION: Combination therapy should thus be recommended as the fi rst line treatment for secondary prophylaxis of oesophageal variceal bleeding.

Genetic diversity of the hepatitis C virus: Impact and issues inthe antiviral therapy

The hepatitis C Virus (HCV) presents a high degree of genetic variability which is explained by the combination of a lack of proof reading by the RNA dependant RNA polymerase and a high level of viral replication. The re- sulting genetic polymorphism defines a classification in clades, genotypes, subtypes, isolates and quasispecies. This diversity is known to reflect the range of responses to Interferon therapy. The genotype is one of the pre- dictive parameters currently used to define the antiviral treatment strategy and the chance of therapeutic suc- cess. Studies have also reported the potential impact of the viral genetic polymorphism in the outcome of antivi- ral therapy in patients infected by the same HCV geno- type. Both structural and non structural genomic regions of HCV have been suggested to be involved in the Inter- feron pathway and the resistance to antiviral therapy. In this review, we first detail the viral basis of HCV diversity. Then, the HCV genetic regions that may be implicated in resistance to therapy are described, with a focus on the structural region encoded by the E2 gene and the non- structural genes NS3, NS5A and NS5B. Both mechanisms of the Interferon resistance and of the new antiviral drugs are described in this review.

Quasispecies evolution in NS5A region of hepatitis C virus genotype 1b during interferon or combined interferon-ribavirin therapy

AIM: To evaluate the implication of substitutions in the hepatitis C virus (HCV) non-structural 5A (NS5A) protein in the resistance of HCV during mono-interferon (IFN) or combined IFN-ribavirin (IFN-R) therapy. Although NS5A has been reported to interact with the HCV RNA- dependent RNA polymerase, NS5B, as well as with many cellular proteins, the function of NS5A in the life cycle of HCV remains unclear. METHODS: HCV quasispecies were studied by clon- ing and sequencing of sequential isolates from patients infected by HCV genotype 1b. Patients were treated by IFN-α2b for 3 mo followed by IFN-α2b alone or com- bined IFN-R therapy for 9 additional months. Patients were categorized intro two groups based on their re- sponse to the treatments: 7 with sustained virological re- sponse (SVR) (quasispecies = 150) and 3 non-respond- ers (NR) to IFN-R (quasispecies = 106). RESULTS: Prior to treatment, SVR patients displayed a lower complexity of quasispecies than NR patients. Most patients had a decrease in the complexity of quasispe- cies during therapy. Analysis of amino acids substitu- tions showed that the degree of the complexity of the interferon sensitivity-determining region (ISDR) and the V3 domain of NS5A protein was able to discriminate thetwo groups of patients. Moreover, SVR patients displayed more variability in the NS5A region than NR patients. CONCLUSION: These results suggest that detailed mo- lecular analysis of the NS5A region may be important for understanding its function in IFN response during HCV 1b infection.

Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction

BACKGROUND ST-elevation myocardial infarction(STEMI)remains a major cause of mortality despite early revascularization and optimal medical therapy.Tailoring individual management by considering patients’specificities may help in improving post-STEMI survival.AIM To evaluate whether in-hospital bleeding complications may be involved in post STEMI prognosis among overweight patients.METHODS We prospectively included 2070 patients with a STEMI between January 2005 and December 2012 in the French observational cohort,“Registre d’Infarctus Maine-Anjou”.Bleeding Academic Research Consortium(BARC)in-hospital bleeding complications were recorded.RESULTS Of 705 patients(35.3%)were presented as being of normal weight,defined as a body mass index(BMI)<25 kg/m^2,877(43.9%)had a BMI between 25 and 30 kg/m^2and 416(20.8%)had a BMI≥30 kg/m^2.One-year cardiovascular mortality was lower for BMI≥25 kg/m^2(5.3%and 7.1%)patients than for normal weight patients(10.8%)(P=0.001).We found an interaction between the effect of BARC 3 on mortality and BMI groups.While a BARC 3 was related to a higher 1-year mortality in general(HR:2.58,95%CI:1.44-4.64,P≤0.001),prognosis was even worse in normal weight patients(HR:2.97,95%CI:1.61-5.5,P<0.001)than for patients with a BMI≥25 kg/m^2(HR:1.94,95%CI:1.02-3.69,P=0.041).CONCLUSION Normal weight patients presented higher rates of in-hospital bleeding complications and lower survival after a STEMI.Excess mortality might be due to greater vulnerability to bleeding amongst normal weight patients.

Recent advances in hepatitis C virus research and understanding the biology of the virus

Since the identification of hepatitis C virus (HCV) genome in 1989[1], a lot of progresses have been done about the understanding of HCV biology, natural history and therapeutic options. HCV is a member of the Flaviviridae viral family. Its genome is a positive simple strand

Subclinical proximal tubulopathy in hepatitis B:The roles of nucleot(s)ide analogue treatment and the hepatitis B virus

BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity,such as estimated glomerular filtration rate(eGFR)and phosphatemia,are late markers of proximal tubulopathy.Multiple early markers are available,but no consensus exists on their use.AIM To determine the 24 mo prevalence of subclinical proximal tubulopathy(SPT),as defined with early biomarkers,in treated vs untreated hepatitis B virus(HBV)-monoinfected patients.METHODS A prospective,non-randomized,multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was conducted.The patients were separated into three groups:Naïve,starting entecavir(ETV)treatment,or starting tenofovir disoproxil(TDF)treatment.Data on the early markers of SPT,the eGFR and phosphatemia,were collected quarterly.SPT was defined as a maximal tubular reabsorption of phosphate/eGFR below 0.8 mmoL/L and/or uric acid fractional excretion above 10%.The prevalence and cumulative incidence of SPT at month 24(M24)were calculated.Quantitative data were analyzed using analyses of variance or Kruskal-Wallis tests,whereas chi-squared or Fisher’s exact tests were used to analyze qualitative data.Multivariate analyses were used to adjust for any potential confounding factors.RESULTS Of the 196 patients analyzed,138(84 naïve,28 starting ETV,and 26 starting TDF)had no SPT at inclusion.At M24,the prevalence of SPT was not statistically different between naïve and either treated group(21.1%vs 30.7%,P<0.42 and 50.0%vs 30.7%,P=0.32 for ETV and TDF,respectively);no patient had an eGFR lower than 50 mL/min/1.73 m²or phosphatemia less than 0.48 mmoL/L.In the multivariate analysis,no explanatory variables were identified after adjustment.The cumulative incidence of SPT over 24 mo(25.5%,13.3%,and 52.9%in the naïve,ETV,and TDF groups,respectively)tended to be higher in the TDF group vs the naïve group(hazard ratio:2.283,P=0.05).SPT-free survival at M24 was 57.6%,68.8%,and 23.5%for the naïve,ETV,and TDF groups,respectively.The median survival time without SPT,evaluated only in the TDF group,was 5.9 mo.CONCLUSION The prevalence and incidence of SPT was higher in TDF-treated patients compared to naïve patients.SPT in the naïve population suggests that HBV can induce renal tubular toxicity.

法国旅游类硕、博士人才培养与学科发展

尽管中国高校当前学科建设的动力、起点、路径、模式都与西方大学存在较大差异,但硕士和博士人才培养向来都是中外高校学科发展的重要内容。多学科介入旅游研究以及旅游学科现有地位与旅游产业重要性严重不符是中外旅游学界共同面对的现象。因而,旅游强国法国在这方面的努力与实践值得正致力于建设旅游管理一级学科的中国同仁们了解与借鉴。

法国旅游的讲述之道

作为全球头号旅游目的地和首个在境外设立旅游推广机构的国家,法国在以旅游叙述法国故事,塑造法国形象,展示法国魅力上的做法有颇多可取之处。笔者试从三个层面谈谈这一话题。

A Hybrid Methodology for Short Term Temperature Forecasting

Developing a reliable weather forecasting model is a complicated task, as it requires heavy IT resources as well as heavy investments beyond the financial capabilities of most countries. In Lebanon, the prediction model used by the civil aviation weather service at Rafic Hariri International Airport in Beirut (BRHIA) is the ARPEGE model, (0.5) developed by the weather service in France. Unfortunately, forecasts provided by ARPEGE have been erroneous and biased by several factors such as the chaotic character of the physical modeling equations of some atmospheric phenomena (advection, convection, etc.) and the nature of the Lebanese topography. In this paper, we proposed the time series method ARIMA (Auto Regressive Integrated Moving Average) to forecast the minimum daily temperature and compared its result with ARPEGE. As a result, ARIMA method shows better mean accuracy (91%) over the numerical model ARPEGE (68%), for the prediction of five days in January 2017. Moreover, back to five months ago, in order to validate the accuracy of the proposed model, a simulation has been applied on the first five days of August 2016. Results have shown that the time series ARIMA method has offered better mean accuracy (98%) over the numerical model ARPEGE (89%) for the prediction of five days of August 2016. This paper discusses a multiprocessing approach applied to ARIMA in order to enhance the efficiency of ARIMA in terms of complexity and resources.

Is COVID-19 different from other causes of acute respiratory distresssyndrome?

Coronavirus disease 2019(COVID-19)pneumonia can lead to acute hypoxemic respiratory failure.When mechanical ventilation is needed,almost all patients with COVID-19 pneumonia meet the criteria for acute respiratorydistress syndrome(ARDS).The question of the specificities of COVID-19-associated ARDS compared to othercauses of ARDS is of utmost importance,as it may justify changes in ventilatory strategies.This review aims todescribe the pathophysiology of COVID-19-associated ARDS and discusses whether specific ventilatory strategiesare required in these patients.

Benzothiadiazole-based materials for organic solar cells

The past few years have witnessed power conversion efficiency(PCE)of organic solar cells(OSCs)skyrocketing to the value of 20%due to the outstanding advantages of organic photoactive materials.The latter,which consist of donor and acceptor materials,indeed play important roles in OSCs,and particularly one building block has attracted considerable research attention,namely benzothiadiazole(BT).The diversity of OSCs based on the BT structure have indeed sprung up,and the progressive increase in PCE values is more than just eye-catching since it heralds a renewal and bright future of OSCs.This review analyzes significant studies that have led to these remarkable progresses and focuses on the most effective BT small-molecules and BT polymers for OSC reported in the last decades.The pivotal structure-property relationships,donor-acceptor matching criteria,and morphology control approaches are gathered and discussed in this paper.Lastly,we summarize the remaining challenges and offer a personal perspective on the future advance and improvement of OSCs.

ABA-Mediated Inhibition of Germination Is Related to the Inhibition of Genes Encoding Cell-Wall Biosynthetic and Architecture： Modifying Enzymes and Structural Proteins in Medicago truncatula Embryo Axis

Radicle emergence and reserves mobilization are two distinct programmes that are thought to control germination. Both programs are influenced by abscissic acid （ABA） but how this hormone controls seed germination is still poorly known. Phenotypic and microscopic observations of the embryo axis of Medicago truncatula during germination in mitotic inhibition condition triggered by 10 μM oryzalin showed that cell division was not required to allow radicle emergence. A suppressive subtractive hybridization showed that more than 10% of up-regulated genes in the embryo axis encoded proteins related to cell-wall biosynthesis. The expression of α-expansins, pectin-esterase, xylogucan-endotransglycosidase, cellulose synthase, and extensins was monitored in the embryo axis of seeds germinated on water, constant and transitory ABA. These genes were overexpressed before completion of germination in the control and strongly inhibited by ABA. The expression was re-established in the ABA transitory-treatment after the seeds were transferred back on water and proceeded to germination. This proves these genes as contributors to the completion of germination and strengthen the idea that cell-wall loosening and remodeling in relation to cell expansion in the embryo axis is a determinant feature in germination. Our results also showed that ABA controls germination through the control of radicle emergence, namely by inhibiting cell-wall loosening and expansion.

Genetic Tabu Search for the Multi-Objective Knapsack Problem

We introduce a hybrid algorithm for the 01 multidimensional multi-objective knapsack problem. This algorithm, called GTS MOKP, combines a genetic procedure and a tabu search operator. The algorithm is evaluated on 9 well-known benchmark instances and shows highly competitive results compared with two state-of-the-art algorithms.

A major step toward efficient and stable single-material organic solar cells

Organic photovoltaics (OPV) can potentially combine low cost, lightness, flexibility and low environmental impact. In less than two decades, the power conversion efficiency(PCE) of OPV cells has increased from 1 to more than 15%thanks to parallel efforts in material design and device technology.