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Winter habitat use by moose (Alces alces) in response to climate change may reflect shifts in biotic and abiotic stressors that pose both environmental challenges and opportunities. Snow depth, temperature, winter length, and forest composition influence moose mobility, habitat use, and access to forage and cover resources. We analyzed habitat selection in winter home ranges of adult female moose (n = 96) over the course of six winters (2014-2019) to explore the influence of winter weather and forest composition on landscape and habitat use. Second order (home range) resource selection functions were estimated using generalized linear mixed models. Moose selected most strongly for forest habitat, specifically evergreen and mixed forests, which had similar strength of selection and represented ~50% of home ranges. The models identified a slight positive association with regenerating forest, although high levels of variance indicated a weak relationship. Contrary to our prediction, we did not detect any influence of weather conditions on winter habitat selection. Maine's mosaic of forest types and commercial forestry seemingly provide adequate food and cover resources for moose regardless of winter conditions, with the three habitat types selected for representing ~70% of home ranges. Due to the coarse resolution of the data we analyzed, more specific data on forest structure such as stand age, canopy, and forage species may be required to identify finer relationships in habitat use and specific resource requirements during winter. It is possible that other factors associated with climate change, such as increases in deer (Odocoileus virginianus) populations, parasites, and disease will have greater influence on moose than habitat per se. However, because these potential influences are indirectly related to habitat use by moose, further research is warranted to best understand the multiple factors and relationships affecting winter habitat use. Key words: Alces alces, seasonal resources, home range, landscape use, New England, weather conditions, winter., INTRODUCTION Moose (Alces alces) population dynamics are largely influenced by forage and cover resources in forest habitats; within Maine's boreal forest moose landscape use is likely driven by access to [...]

Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts.

Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) score. This study revisited the SOFA score and created a new simplified and accurate sa-SOFA score.

L’infection est un risque pour toute intervention et, par exemple, en chirurgie l’on retrouve des bactéries pathogènes dans plus de 90 % des plaies opératoires, lors de la fermeture. Ceci existe quelle que soit la technique chirurgicale et quel que soit l’environnement (le flux laminaire ne supprime pas complètement ce risque). Ces bactéries sont peu nombreuses mais peuvent proliférer. Elles trouvent dans la plaie opératoire un milieu favorable (hématome, ischémie, modification du potentiel d’oxydoréduction…) et l’intervention induit des anomalies des défenses immunitaires. En cas d’implantation de matériel étranger le risque est majoré. L’objectif de l’antibioprophylaxie (ABP) est de s’opposer à la prolifération bactérienne afin de diminuer le risque d’infection du site de l’intervention. La consultation préopératoire représente un moment privilégié pour décider de la prescription d’une ABP. Il est possible d’y définir le type d’intervention prévu, le risque infectieux qui s’y rapporte (et donc la nécessité ou non d’une ABP), le moment de la prescription avant l’intervention et d’éventuels antécédents allergiques pouvant modifier le choix de la molécule antibiotique sélectionnée.

Why is there war? Do people really know? It's not written on your brow, "MAKE WAR!" You don't have to be blind Don't people have a mind? What's the goal? […]

Cet article présente un protocole d’évaluation interdisciplinaire portant sur les fonctions perceptives et praxiques chez l’enfant. La compréhension du terme « dyspraxie » a été le point de départ de notre démarche, dans un souci de mieux répondre à certaines difficultés notées chez les enfants avec lesquels nous travaillons. Ceux-ci présentent pour la plupart une paralysie cérébrale avec des capacités intellectuelles relativement préservées. Nous avons rassemblé les données récentes de la littérature au sein d’un modèle théorique. Celui-ci a servi de base à l’élaboration et à la recherche d’épreuves standardisées capables de mettre en évidence des troubles praxiques et perceptifs. Plusieurs grands domaines sont ainsi explorés. Tout d’abord, nous abordons l’évaluation du « regard » (vision centrale et périphérique, oculomotricité, coordination œil-main, balayage visuel et stratégies exploratoires visuelles), préalable indispensable à l’évaluation des fonctions perceptives et praxiques. Ensuite, une réflexion sur l’évaluation des traitements perceptivo-spatiaux, visuo-perceptifs et visuo-constructifs est proposée. Enfin, nous discutons des aspects idéomoteurs, idéatoires ainsi que de la pertinence d’évaluer dans ce contexte les praxies bucco-linguo-faciales. L’intérêt de ce protocole réside dans le fait qu’il allie et intègre les données de la littérature ainsi que l’expérience clinique d’une équipe de professionnels qui travaille en interdisciplinarité (neuropsychologue, ergothérapeute, logopède et kinésithérapeute). L’évaluation permet de poser un diagnostic différentiel précis visant une prise en charge efficace et ciblée.

Stars are giant thermonuclear plasma furnaces that slowly fuse the lighter elements in the universe into heavier elements, releasing energy, and generating the pressure required to prevent collapse. To understand stars, we must rely on nuclear reaction rate data obtained, up to now, under conditions very different from those of stellar cores. Here we show thermonuclear measurements of the 2H(d, n)3He and 3H(t,2n)4He S-factors at a range of densities (1.2–16 g cm−3) and temperatures (2.1–5.4 keV) that allow us to test the conditions of the hydrogen-burning phase of main-sequence stars. The relevant conditions are created using inertial-confinement fusion implosions at the National Ignition Facility. Our data agree within uncertainty with previous accelerator-based measurements and establish this approach for future experiments to measure other reactions and to test plasma-nuclear effects present in stellar interiors, such as plasma electron screening, directly in the environments where they occur.

Septic shock is associated in some patients with a profound immunosuppression. We hypothesized that GM-CSF would reduce the occurrence of ICU-acquired infections in immunosuppressed septic patients.

New laser-driven flyer impact experiments have been performed at the LULI laboratory. In these experiments, three types of targets (single Al flyer, multi-layered, and foam-buffered high-Z metal) were used. Impacted conditions in fused quartz were measured with rear-side (two VISARs and SOP) and transverse diagnostics (shadowgraph). In the foam-buffered target, Ta foil was accelerated up to a velocity of 55 km/s. Shock wave accelerated in fused quartz by an Al flyer impact was generated, and the shock wave passing a distinct boundary to a conductive state was directly observed. This method is a way to create unique conditions within the EOS diagram of material.

We present here a summary of various and preliminary experiments performed on the new facility LULI 2000. Four topics in the High Density Energy Physics have been investigated:
a– Equation of State: we studied pre-compressed water, one of most abundant component of Uranus and Neptune's mantle. We used a recent technique based on generating a shock into a diamond anvil cell pre-compressed target. Some new data on EOS surface in the range 2-3 Mbar have been obtained.
b– X-ray Thomson scattering: a strongly coupled and degenerated Aluminum plasma has been produced and probed by Ti He-alpha radiation. By using a curved spectrometer, the scattered spectrum has been measured a Compton shift from electrons has been put in evidence.
c– Astrophysics in the laboratory: A radiative supercritical shock has been produced into a gas cell filled with a low density of Xenon (0.1-0.3 bar). Various diagnostics have been implemented to determine electron density variation, precursor and shock velocities, the 2D shape of the shock at different times and electron temperature.
d– Laser accelerated flyer: different flyer plate targets have been tested. Typical shock loaded material was fused-quartz plate. Flyer velocities up to 55 km/s have been measured.

Mesurer le développement d’une culture de sécurité (CS) des soins en réanimation par le Safety Attitudes Questionnaire (SAQ), un outil de mesure comportant une version spécifique à la réanimation (SAQ-ICU). L’objectif de cette étude est de réaliser la version française de ce questionnaire nord-américain, puis de l’utiliser pour mesurer le niveau de la CS dans 2 unités de réanimation. Réalisation avec le consentement des auteurs d’une version française du SAQ-ICU testée et validée par rétrotraduction. Ce questionnaire comporte 30 items explorant 6 dimensions de la CS (esprit d’équipe ; climat de sécurité ; satisfaction au travail ; reconnaissance du stress ; perception de l’équipe d’encadrement ; conditions de travail), considérées comme « développées » (score est >75 %) et « à améliorer » (<50 %). Il a été administré à tous les professionnels (médecins, AS, IDE) exerçant dans les 2 unités. Cent seize questionnaires ont été récupérés (83 % de réponse). Les répondeurs ont un âge médian de 36ans, une ancienneté médiane professionnelle de 10ans et dans le service de 4,5ans. Les résultats sont superposables dans les 2 unités, 4 dimensions sur 6 obtiennent un score entre 50 et 75 % et deux dimensions (perception de l’équipe d’encadrement ; conditions de travail) sont « à améliorer » (score<50 %). Le SAQ-ICU permet d’étudier la culture de sécurité en réanimation. Une étude nationale est en cours utilisant la version française du SAQ-ICU dans un nombre plus important d’unités (PREPS 2012).

Neutrophil phenotypic, functional, and morphological alterations during sepsis‐induced immunosuppression suggest a deleterious role during post‐sepsis immune reprogramming. Severe septic syndromes deeply impair innate and adaptive immunity and are responsible for sepsis‐induced immunosuppression. Although neutrophils represent the first line of defense against infection, little is known about their phenotype and functions a few days after sepsis, when the immunosuppressive phase is maximal (i.e., between d 3 and 8). The objective of the present study was to perform, for the first time, a global evaluation of neutrophil alterations in immunosuppressed septic patients (at d 3–4 and d 6–8) using phenotypic and functional studies. In addition, the potential association of these parameters and deleterious outcomes was assessed. Peripheral blood was collected from 43 septic shock patients and compared with that of 23 healthy controls. In the septic patients, our results highlight a markedly altered neutrophil chemotaxis (functional and chemokine receptor expressions), oxidative burst, and lactoferrin content and an increased number of circulating immature granulocytes (i.e., CD10dimCD16dim). These aspects were associated with an increased risk of death after septic shock. In contrast, phagocytosis and activation capacities were conserved. To conclude, circulating neutrophils present with phenotypic, functional, and morphologic alterations a few days after sepsis onset. These dysfunctions might participate in the deleterious role of sepsis‐induced immunosuppression. The present results open new perspectives in the mechanisms favoring nosocomial infections after septic shock. They deserve to be further investigated in a larger clinical study and in animal models recapitulating these alterations.

Intravascular-catheter-related infections are frequent life-threatening events in health care, but incidence can be decreased by improvements in the quality of care. Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections. We hypothesised that chlorhexidine–alcohol would be more effective than povidone iodine–alcohol as a skin antiseptic to prevent intravascular-catheter-related infections.

IL‐7 can activate ex vivo CD4+effector and regulatory cells from surviving and non‐surviving septic patients through STAT5 phosphorylation measurement. Septic shock is characterized by lymphocyte alterations associated with increased risk of nosocomial infections and mortality. IL‐7, a cytokine required for T cell survival, is thought as a novel therapy for septic patients with severe lymphopenia. We assessed CD4+lymphocyte responsiveness to rhIL‐7 in septic shock patients ex vivo. Thirteen septic shock patients and 10 controls were included. The MFI of pSTAT5, a key signaling molecule for IL‐7, was measured by flow cytometry in CD4+FOXP3− (Teffs) and CD4+FOXP3+(Tregs) lymphocytes after whole‐blood incubation with increasing doses of rhIL‐7. The basal level of pSTAT5 in nonstimulated T cells was higher in patients. However, the maximal activation level in response to the highest doses of rhIL‐7 was similar in both groups. Importantly, low doses of rhIL‐7 preferentially activated Teffversus Tregin patients and nonsurvivors tended to present with decreased pSTAT5 expression. This pilot study is the first to highlight, in septic patients, the interest of pSTAT5 measurement in whole blood for the monitoring of rhIL‐7 therapy. Such a method could represent an innovative, biologic tool for monitoring leukocyte pharmacological responses to biotherapies in daily clinical practice in other clinical contexts.

La surcharge fréquente de nos services d’accueil des urgences (SAU) entraîne le développement de la pratique de la réorientation, qui ne fait l’objet d’aucune recommandation officielle en France. L’objectif de ce travail était de décrire les habitudes des urgentistes en matière de réorientation des patients à l’accueil des urgences. Étude rétrospective, descriptive et multicentrique, réalisée sur la base d’un questionnaire disponible en ligne et destiné aux médecins urgentistes des 26 centres hospitaliers universitaires français (CHU). Sur les 169 médecins urgentistes ayant répondu à l’étude, 141 (83 %) déclaraient pratiquer la réorientation et 37 (26 %) basaient leurs critères de réorientation sur des données issues de la littérature. Quatre-vingt-douze médecins (65 %) réorientaient moins de cinq patients par jour. Cent six médecins (75 %) déclaraient réorienter leurs patients vers leur médecin traitant, 88 (62 %) vers les maisons médicales de garde et 36 (25 %) vers le domicile. Les médecins refusant de réorienter le faisaient par pression de leur service, par manque de solution d’aval et par crainte du risque médicojudiciaire. Quatre-vingt-dix médecins (54 %) déclaraient recevoir des directives de leur SAU en matière de réorientation, positives pour 90 % d’entre eux. La réorientation à l’accueil des urgences est une réalité pour une majorité d’urgentistes. Cette pratique reste peu étudiée en France, sans cadre légal ni recommandations officielles. Frequent overcrowding of emergency departments (EDs) leads to the development of the practice of triage out, which is not subject to any formal recommendation in France. The aim of this study was to describe the French physicians habits about redirecting their patients out from the ED. This was a retrospective, descriptive, multicentric study. A survey available online was sent to the 26 French university hospital EDs. A total of 169 emergency physicians answered to the survey, 141 (83%) of them reported practicing triage out and 37 (26%) rely their decisions with data from the literature. There were fewer than 5 patients per day for 92 physicians (65%). One-hundred and six physicians (75%) reported redirecting patients to their general practitioner, 88 (62%) to general medicine departments, and 36 (25%) to their home. Most of the physicians refusing triage suffer from ED pressure, lack of local solutions, and fear of medico-legal issues. Ninety physicians (54%) had a hospital policy shift about triage out, positive in 90% of cases. Triage out in France is a usual practice, suffering from lack of supervision and official recommendations.

In a multicenter surveillance of intensive care unit (ICU)–acquired infections, adjusted ventilator-associated pneumonia (VAP) incidence diminished by −1.0% per year (95% confidence interval [CI], −1.8 to −0.2; P= .02) in ICUs with continuous surveillance but increased by +16.1% (95% CI, 0.5%–34.1%; P= .04) in the year following surveillance disruption, suggesting a preventive effect of surveillance on VAP.Infect Control Hosp Epidemiol 2014;35(10):1290–1293

Several recent reports have identified TET1 as the main enzyme modulating DNA methylation and gene transcription via hydroxylation of 5-methylcytosine. However, little is known about the protein network that controls TET1 activity. By using a new proximity ligation in situassay, we identified MeCP2, HDAC1/6/7, EZH2, mSin3A, PCNA, and LSD1 as TET1-interacting proteins. We also discerned that TET1/PCNA acts as a demethylator of the cyclical methylation/demethylation process, the perturbation of which promotes the aberrant methylation hallmarks frequently observed in cancer cells.

The article offers information on coffrets à stampe, small wooded boxes covered with leather and laced with stips of iron. Coffrets à stampe is usually made with beech, and its inner lid is decorated with a hand-colored woodcut. According to the author, coffrets à stampe is also known as messenger boxes or missal boxes, but their original function is not known.

Risk stratification could represent a major improvement in critically ill patients' management. The objective of this study is to evaluate the association between concentrations of four circulating prohormones (C-terminal-provasopressin, midregional-proadrenomedullin (MR-proADM), midregional-proatrial natriuretic peptide, and C-terminal- proendothelin-1) and the occurrence of nosocomial infections (NIs) in septic shock patients.

A dramatic decrease in circulating lymphocyte number is regularly described after septic shock. However, it is unknown how early this alteration develops after diagnosis of shock and if it remains stable over time. Twenty-one septic shock patients with no comorbidities were included within 2 h after the beginning of vasopressive treatment. Flow cytometry phenotyping of circulating leukocyte subpopulations and quantitative real-time polymerase chain reaction of T-bet, GATA-3, FOXP3, and ROR mRNA were performed in patients from the diagnosis of shock and every 6 h during the subsequent 48 h. From their admission in the intensive care unit, patients present with major alterations of circulating leukocyte count (leukocytosis, neutrophilia, and major lymphopenia). The numbers of every lymphocyte subpopulations (T, B, and natural killer cells) were diminished. Gene expression analysis of transcription factors specific for TH1, TH2, CD4+CD25+regulatory, and TH17 lymphocytes showed a severe decrease in comparison with healthy individuals' values. These alterations remain stable during the first 48 h after inclusion in the protocol despite early and aggressive resuscitation and antibiotherapy administered in patients. At the time of diagnosis of shock and admission in the intensive care unit, septic patients already present with severe lymphopenia involving every lymphocyte subsets including CD4+T-cell subpopulations. No significant variation could be detected within the first 48 h. This should be taken into account in the forthcoming clinical trials testing immunomodulating therapies in septic shock patients.

Background.The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.Objective.TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.Setting.Eleven ICUs of a French university hospital.Design.We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.Results.Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.Conclusions.ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.

Periods of political and religious instability often caused migrations of craftspeople and artists, as happened in the southern Netherlands during the last two decades of the 16thcentury. A number of Antwerp engravers began to settle in Paris on the ‘Rive Gauche’. They introduced the technique of the burin, which would soon be embraced by Parisian print and book publishers, who were used to work with woodcutters. Among them, we can mention Nicolas and Michel de Mathonière, sons of the woodcut publisher Denis de Mathonière. While Michel continued to edit woodcuts like his father, Nicolas saw the opportunities of burin engraving and decided to contribute to the diffusion of the ‘flemish’ prints in Paris at the end of the 16thcentury till the 1630s. He collaborated intensively with the Antwerp engraver Justus Sadeler, who was residing in Venice. Beside, he co-operated with engravers with Flemish roots, who lived and worked in the French capital. During his career, Nicolas de Mathonière had engraved copies made after prints by ‘flemish’ and ‘dutch’ artists: e.g. Hieronymus Wierix and Crispijn de Passe. De Mathonière also republished — like his colleagues from the southern Netherlands — Antwerp prints of the 16thcentury.

Plusieurs études ont montré qu’il existe une confusion entre les différents types de sédation et que l’appropriation des référentiels existants est inégale par les professionnels. Les équipes mobiles de soins palliatifs (EMSP), avec une activité intra- et extrahospitalière sont le premier recours en matière de pratiques sédatives. Cette étude explorait les représentations des EMSP concernant l’utilisation d’un guide sur les pratiques sédatives (GPS).

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P= .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P= .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

Septic syndromes still remain a major but largely under-recognized healthcare problem worldwide accounting for thousands of deaths every year. Despite numerous clinical trials, therapies have failed to mitigate the devastating effects of these conditions. It is now agreed that the initial hypotheses for sepsis pathophysiology have been misconstrued. Sepsis deeply perturbs immune homeostasis by concomitantly inducing a strong inflammatory response and a major antiinflammatory process, acting as a negative feedback. Several lines of evidences indicate that this inhibitory response secondly may be deleterious in patients who survived initial resuscitation, as it may be directly responsible for worsening outcome by decreasing resistance to secondary nosocomial infections. In this context, while the majority of clinical and basic science conducted so far has focused on innate immune cell depressed functions (especially monocytes), the contribution of T lymphocyte anergy has been somewhat ignored. This review focuses on lymphocyte dysfunctions described so far in patients and on potential new therapeutic strategies aimed at restoring a functional lymphocytic response after sepsis.

In the last few years, high power lasers have demonstrated the possibility to explore a new state of matter, the so-called warm dense matter. Among the possible techniques utilized to generate this state, we present the dynamic compression technique using high power lasers. Applications to planetary cores material (iron) will be discussed. Finally new diagnostics such as proton and hard-x-ray radiography of a shock propagating in a solid target will be presented.

AbstractObjective:To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.Design:Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.Setting:Orthopedic surgery wards in a 2,200-bed French teaching hospital.Patients:A random sample of 416 patients undergoing THR from January 1999 to December 2000.Results:Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P< .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).Conclusion:The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.

We studied, retrospectively, postoperative infectious complications following paediatric liver transplantation at a single university centre. The objectives were to characterize the epidemiology of infection and to determine the associated risk factors during the early postoperative period, either the first postoperative month or the entire duration of paediatric intensive care unit (PICU) stay. Forty‐eight liver transplants were performed on 46 patients. Sixty‐three infections occurred in 32 patients who underwent 34 liver transplantations (1.36 infection/patient); 47 were bacterial, 6 fungal and 10 viral. The most common sites of infection were bloodstream (36.5%) and abdomen (30%). Gram‐positive bacteria (78%) predominated over gram‐negative bacteria (22%). Initial analysis revealed infection risk factors to be age <1 year, body weight <10 kg, extrahepatic biliary atresia, intraoperative transfusion > 160 ml·kg−1, mechanical ventilation > 8 days and PICU stay > 19 days. After stratified analysis, the main risk factor for infection was low body weight of the recipient.

The objectives of this study were to identify the risk factors of nosocomial pulmonary infection (NPI) in intensive care units (ICUs) associated with antimicrobial-resistant bacteria (NPI-ARB) and to compare survival after NPI-ARB with NPI due to antimicrobial-sensitive bacteria (NPI-ASB). We analysed data from a surveillance network monitoring nosocomial infections in 27 mixed ICUs in the south-east of France. NPI surveillance data were recorded for 628 patients with documented NPI. The patients were stratified into 2 groups by type of pneumonia: NPI-ASB (445 patients) vs. NPI-ARB (183 patients). Variables associated with NPI-ARB were identifed by multivariate logistic regression. Survival was calculated using the Kaplan–Meier method. A medical condition for ICU admission [odds ratio (OR) 1.98, 95% confidence interval (95% CI) 1.35–2.91], transfer from another hospital ward [OR 1.66, 95% CI (1.14–2.42)], a colonized central venous catheter [OR 3.47, 95% CI (1.46–8.21)], a stay of [eight days [OR 1.02, 95% CI (1.01–1.05)] and mechanical ventilation [OR 2.10, 95% CI (1.31–3.36)] were independent risk factors of NPI-ARB. Median survival was 35 days after NPI-ARB and 32 days after NPI-ASB (P=0.92). Survival after bacterial NPI was not associated with antimicrobial susceptibility.

Surveillance of nosocomial infections associated with anaesthesia. A multicentre survey.

We present a class of models for the surface of a liquid metal, which may be part of an electrochemical interface. The particles of the system, for the purpose of derivation of thermodynamic properties, are the charged ion cores, while the energy of the electrons is evaluated using the electron density functional formalism, previously principally applied to solids. An expression for the surface energy Us, defined as the energy required to create unit area of surface by separation of a volume of homogeneous metal into two parts, is derived (Eqs. 18-20). The surface tension γ is obtained by differentiating the Helmholtz free energy with respect to the area of the system, keeping volume and particle number constant (Eqs. 27-37). The surface tension is also equal to the difference between the free energy of the system containing a surface and the free energy of a reference system. It thus defines a surface energy through the Gibbs-Helmholtz equation, and this surface energy is shown to be identical to Us.The expressions for Us and γ are made explicit (Eqs. 45-57) by insertion of particular assumptions for the ion-density profile, the electron-density profile, the interionic interaction and pair distribution function, and the electronic energy. Only information about bulk liquid metal is used. The parameter in the electron-density profile is obtained by minimizing the surface energy. The simplest assumption for the interionic interaction, hard-sphere and Coulombic repulsions, requires a choice for the hard-sphere diameter, which is made such that the pressure of bulk metals is given correctly (52-55). For the alkali metals, the surface tension calculated from this model is about half the experimental value in each case, while calculated surface energies are too high (1/5 too high for Cs, but three times too high for Li). For the electrical potential difference between the inside and the outside of a metal, and for the electrochemical potential, agreement with experiment is good. The main reason for the disagreements in the other properties is traced to the simple form used for the ion pair distribution function.

L'état d'agression est caractérisé par des perturbations métaboliques multiples mises en jeu par des médiateurs hormonaux et par plusieurs cytokines (TNF, IL1, IL6) intervenant le plus souvent de façon combinée. L'hyperglycémie par augmentation de la production endogène de glucose est constante, traduisant une diminution de la sensibilité à l'insuline des tissus périphériques comme du tissu hépatique. Les lipides endogènes contribuent de façon importante à la fourniture énergétique, en particulier grâce à une augmentation de la lipolyse adipocytaire. L'utilisation des lipides exogènes est habituellement bonne mais doit se discuter chez les patients les plus graves. La protéolyse musculaire est massive ; elle fournit les substrats essentiels aux synthèses protéiques, hépatiques et périphériques indispensables à la guérison du malade. Parmi les nouveaux substrats intéressants sur le plan expérimental, les triglycérides à chaîne moyenne, les acides aminés à chaîne ramifiée n'ont pas réellement fait la preuve de leur intérêt clinique ; d'autres sont à l'étude et paraissent prometteurs : acides gras polyinsaturés n-3, arginine, précurseurs de la glutamine.

Abstract: Infection caused by Corynebacterium JK (CJK) has been recently described in immunocom-promised patients. To evaluate the frequency of CJK infection among surgical and trauma intensive care patients, all patients with CJK isolations at clinical sites were reviewed. The criteria used were the presence of bacterial infection symptoms, isolation from significant sites and the efficiency of a vancomycin treatment. Eight patients were studied; 3 of them were considered infected, while 5 were judged only colonized. It is concluded that CJK infections can be a clinical problem in surgical trauma patients.

This study explored the relationship between cytokines (TNF, IL-1, IL-6), coagulation and fibrinolytic factors in the early stage of sepsis syndrome and the relation between these factors with the severity of inflammatory illness as measured by the Simplified Acute Physiology Score (SAPS). Twenty-one normal controls were compared to 34 patients divided into three categories ranging from uncomplicated postoperative patients, to patients with severe infectious conditions including septic shock. A major hemostatic imbalance was demonstrated with particularly marked reduction in fibrinolytic activity [drop of antithrombin III (ATIII) and protein C with an increase of plasminogen activator inhibitor (PAI-1) levels] which were directly correlated with the severity of the inflammatory state. Both ATIII and PAI-1 levels were correlated with the levels of TNF and IL-6 and the severity of illness as measured by SAPS. We established an index, ATIII/PAI-1 antigen that is significantly different among the four groups (p < 0.001) and strongly correlated with the SAPS (p < 0.001). As PAI-1 could be secreted not only by TNF activating endo-thelial cells but also by hepatocytes activated by insulinemia, treatment of sepsis with cytokine-specific agents might be of limited effect.

Nine sera with falsely elevated results in a TSH radioimmunoassay were studied. Sera dilution and gel filtration showed that the immunoreactive TSH was different from the standard and labeled TSH. It coeluted with the immunoglobulin fraction of the seru. Rabbit serum decreased or emphasized the artifact according to the dose. Falsely elevated results appeared only in radioimmunoassays using a double antibody method for the separation of free and bound labeled hormone. FSH, LH, and ßHCG radioimmunoassays using the double antibody method underwent the same disturbance as the TSH assay in these patients. Our results suggest that the artifact may be due to the presence in certain human sera of anti-rabbit lgG antibodies, interfering in the radioimmunoassay by inhibition of the binding of first and second antibodies.

The anaerobic ribonucleoside triphosphate reductase of Escherichia coli is an iron-sulfur protein carrying an oxygen-sensitive organic radical, which is essential for catalysis. The radical was tentatively proposed to be on glycine 681, based on a comparison with the glycyl radical-containing enzyme pyruvate formate-lyase. By EPR spectroscopy of selectively 2H- and 13C-labeled anaerobic ribonucleotide reductase, the radical was now unambiguously assigned to carbon-2 of a glycine residue. The large 1H hyperfine splitting (1.4 millitesla) was assigned to the alpha-proton. Site-directed mutagenesis was used to change glycine 681 into an alanine residue. In separate experiments, the two adjacent residues, cysteine 680 and tyrosine 682, were changed into serine and phenylalanine, respectively. All mutated proteins were retained on dATP-Sepharose, indicating that the mutant proteins had intact allosteric sites. They also contained amounts of iron comparable with the wild type reductase and showed the same iron-sulfur-related spectrum, suggesting that the mutant proteins were properly folded. Of the three mutant proteins only the G681A protein completely lacked the detectable glycyl radical as well as enzyme activity. Our results identify glycine 681 as the stable free radical site in E. coli anaerobic ribonucleotide reductase.

Two cases of severe infection due toStreptococcus pyogenes associated with a toxic-shock-like syndrome (TSLS) and also with serious soft-tissue infection are described. Serotyping and detection of A, B and C exotoxins were carried out on strains isolated from blood cultures and skin samples. The strain of serotype M1 T1, which produced 10 ng/ml of exotoxin A and also synthesised exotoxins B and C, caused severe TSLS associated with major skin lesions. The second strain of serotype M12 T12, which produced only 1 ng/ml of exotoxin A and synthesised exotoxin B, was associated with clinical manifestations of adult respiratory distress syndrome. The relationship between the magnitude of exotoxin production and the severity of clinical manifestations cannot be established from these two cases.

Amikacin is commonly used for probabilistic antimicrobial therapy in critically ill patients with sepsis. Its narrow therapeutic margin makes it challenging to determine the right individual dose that ensures the highest efficacy target attainment rate (TAR) in this setting. This study aims to develop a new initial dosing approach for amikacin by optimizing the a prioriTAR in this population.

Les fractures du scaphoïde représentent la majorité des fractures du carpe. L’absence de diagnostic est lourde de conséquence pour les patients avec l’apparition rapide d’arthrose. Entre septembre 2014 et septembre 2015, 50 patients ont présenté un traumatisme du poignet avec une symptomatologie clinique en faveur d’une fracture scaphoïde mais à radiographie normale aux urgences. L’objectif de cette étude était d’évaluer la proportion de fractures de scaphoïde occultes aux urgences.

Les ILC sont des infections associées aux soins, fréquentes et potentiellement mortelles dont l’incidence peut être diminuée par l’amélioration de la qualité des soins. Nous avions émis l’hypothèse que la chlorhexidine alcoolique à 2 % (CHG-OH) était plus efficace que la povidone iodée alcoolique à 5 % (PVI-OH) comme antiseptique cutanée pour prévenir les ILC de courte durée et que la réalisation d’une détersion cutanée avec un savon antiseptique avant l’application de l’antiseptique ne diminuait pas le risque de colonisation des cathéters.