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The treatment of neutrophilic panniculitis can be challenging. We report a patient with a difficult-to-treat neutrophilic panniculitis who had a spectacular response to a short treatment course with the IL-1 antagonist anakinra. A 61-year-woman had a 12-year history of a serious febrile neutrophilic panniculitis and a personal history of steroid- induced pancreatitis and life-threatening methemoglobinemia under antimalarials and dapsone. When she developed a new flare, she was treated successfully with a 15-day course of subcutaneously administered injections of 100 mg anakinra. This observation is the first report attesting the efficiency of anakinra in neutrophilic panniculitis. It expands the potential indications of IL-1 inhibition in the field of the neutrophilic dermatoses, or more generally, in neutrophil-mediated systemic diseases. It underscores the potential pathogenic involvement of IL-1 in those diseases, a hallmark of autoinflammation, and supports their nosologic classification among diseases involving primarily the innate immune system.

BackgroundFrailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults.MethodsA prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts’ point of view. The association between items response and tests with “help requested status” was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject.ResultsBetween May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value < 0.0001), with sensitivity of 81%, specificity of 61%, positive predictive value of 93%, negative predictive value of 34%, and a global predictive value of 78%.ConclusionsThe FRAGIRE seems to have considerable potential as a reliable and effective tool for identifying frail elderly individuals by a public health social worker without medical training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0360-9) contains supplementary material, which is available to authorized users.

Spawning and nursery habitats are often spatially disjunct as a consequence of specific life history stage habitat requirements and spatiotemporal habitat changes. Nevertheless, free‐swimming larvae originating from spawning habitats must reach productive nurseries to maximize survival. We examined spawning and nursery habitats of northern pike (Esox lucius) over the past 50 yr to investigate how habitat connectivity and hydrological variability interact to alter the distribution of effective spawning habitat. Habitat models coupled to a least‐cost approach were developed to quantify connectivity between habitats in two contrasting regions of the St. Lawrence River (Canada): a riverine corridor lake (~ 46 km) and a large fluvial lake (~ 48 km). Our simulations demonstrate that depending on hydrological conditions, between 3% to 51% of spawning habitat used by adults in the riverine corridor, and 22% to 90% in the lake, allowed larval survival up to the fifth week of development. Although rapid dewatering of spawning habitat is responsible for most spawning losses in the fluvial lake, increasing water currents were responsible for dispersing larvae away from suitable habitats in the riverine corridor. However, stable hydrological conditions led to spatial overlapping of spawning and nursery habitats favoring larval survival and growth. In addition, downstream larval dispersal by low water currents allowed larvae to reach spatially disjunct nursery habitat, especially in the lake. Our results indicate that despite the vast areas of potentially suitable habitats provided by large vegetated floodplains of fluvial lakes, the effective spawning habitats favoring early‐life recruitment are much more heterogeneous and variable both spatially and temporally.

Impact of drug exposure for AA tyrosine kinase inhibitors activity has been demonstrated in mRCC setting. Interpatients EBC variability was confirmed in the present study, and the results suggest a relationship between initial EBC within the first 3 months and the drug activity. It underlines the need to prospectively include EBC monitoring in future clinical trials to determine the need of its implementation in routine use.

BackgroundMedical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers.Methods/designThe aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson’s disease, Alzheimer’s disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken.DiscussionThrough an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies.Trial registrationClinicalTrials.gov Identifier: NCT02626377. Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2.

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Hydrological and land use changes for human needs, have resulted in the increased fragmentation of river landscapes and the loss of aquatic habitats, leading to profound changes in fish diversity and productivity. ObjectivesIn the fluvial Lake Saint-Pierre (St. Lawrence River, Canada), we studied how riparian agriculture and water flow regulation have impacted the effectiveness of spawning habitats of northern pike (Esox lucius). MethodsNorthern pike spawning and nursery habitats were modelled over a 49-years period to estimate effective spawning areas under four contrasted hydrological conditions. ResultsThese simulations, coupled with land-use analyses, revealed that natural flow conditions usually favourable to fish reproduction have been lost due to human activities. The highest potential for reproduction, usually associated with high and stable water flows, has been lost due to (1) intensive agriculture in the upper floodplain Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporationthat overlaps with suitable habitats for fish, and (2) flow regulation that leads to more frequent drying of spawning grounds. These profound anthropogenic changes have resulted in a significant loss of reproductive potential for northern pike and other fish species that use the floodplain to complete their life cycle. ConclusionsThis study suggests the need to convert intensive agriculture into natural wetlands or perennial crops and to restore a more natural flow regime by extending the duration of floods between spawning and nursery periods. The highest priority areas for restoration are the most effective and recurrent spawning habitats, ditch and stream networks, and connected managed wetlands.