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Glucocorticoids probably improve outcomes in patients hospitalised for community acquired pneumonia (CAP). In this a priori planned exploratory subgroup analysis of the phase 3 randomised controlled Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trial, we aimed to investigate responses to hydrocortisone plus fludrocortisone between CAP and non-CAP related septic shock.

ObjectivesIn France, when the patient is unable to express his wishes, the decision to withhold or withdraw life-sustaining treatment (WWLST) is made following a collegial procedure described by a law. The aim of our study was to assess how closely this WWLST decision-making procedure in end of life patients was maintained during the COVID-19 pandemic.MethodsThis retrospective observational multicentre study compared the rate of non-compliance with WWLST decision-making procedures during the pandemic period from March to June 2020 with control period in 2019, in Clermont-Ferrand and Lyon Hospitals. Secondary objectives were to determine the factors associated with non-compliance.ResultsIn 430 deceased patients included (176 in 2019 and 254 in 2020), the rate of non-compliance was 61.4% in 2019 and 59.1% in 2020 (p=0.63). In multivariable analysis, non-compliance was associated with immunosuppression status (OR 1.69, 95% CI (1.12 to 2.54), p=0.01) but was lower in intensive care unit (OR 0.54, 95% CI (0.36 to 0.82), p=0.003) and when the patient had visits from relatives (OR 0.41, 95% CI (0.22 to 0.75), p=0.004).ConclusionIn France, more than half of WWLST decisions do not comply with the law. The COVID-19 pandemic did not increase this non-compliance rate. Further studies are needed for a better understanding of the mechanisms underlying non-compliance with WWLST decision-making procedure.Trial registration numberNCT04452487.

Silicon nitride (SiN) has emerged as a key platform for integrated nonlinear photonics by leveraging its excellent optical properties and high fabrication maturity. SiN nonlinear integrated devices can provide efficiency, bandwidth and practicality. Here we show their exceptional performances for Kerr comb generation and frequency conversion. We also show how by inducing the intrinsically lacking 2ndorder nonlinearity we can bring new nonlinear functionalities to the platform.

Las afecciones tóxicas, medicamentosas y endocrinas del músculo son frecuentes y a menudo poco conocidas. Se manifiestan por dolores musculares invalidantes que suelen remitir cuando se elimina el tóxico, se suspende el tratamiento inductor o se trata la causa endocrina. En raras ocasiones, se pueden acompañar de rabdomiólisis y poner en peligro la vida del paciente. Los tratamientos y tóxicos inductores son cada vez más numerosos por la aparición de nuevas moléculas y nuevas drogas. Por consiguiente, es difícil establecer una lista exhaustiva, pero ante una afección muscular, siempre se debe considerar esta hipótesis. Cabe recordar que las mialgias, con independencia de sus causas, representan entre el 10-25% de las consultas de reumatología, y el 50% de ellas tiene una causa orgánica. Su detección está esencialmente orientada por una anamnesis muy precisa y exhaustiva, en particular para las causas tóxicas. Las etiologías endocrinas están esencialmente representadas por los distiroidismos, que son los más conocidos, pero no hay que olvidar otras como las afecciones suprarrenales, hipofisarias, paratiroideas, etc. La fisiopatología de estas afecciones depende evidentemente del elemento desencadenante y cada vez se conocen con mayor precisión los mecanismos subyacentes. Provocan disfunciones que repercuten en el metabolismo de la célula muscular (por ejemplo, alteración de los canales del calcio, etc.), pero que también pueden afectar a otros órganos (por ejemplo, la posible implicación de anomalías de proteínas hepáticas en las mialgias por estatinas).

La muñeca es especialmente propensa a las patologías traumáticas, microtraumáticas e inflamatorias. Un buen enfoque clínico, la radiografía estándar y la ecografía son suficientes para establecer un diagnóstico en la mayoría de los casos. La artritis aguda, séptica o microcristalina es una emergencia. Si existe la más mínima duda sobre una artritis séptica, el paciente debe ser remitido urgentemente a un centro que pueda tomar muestras bacteriológicas antes de cualquier tratamiento antibiótico. Las enfermedades inflamatorias están representadas por el reumatismo inflamatorio crónico, en particular la artritis reumatoide, la artritis microcristalina, especialmente la condrocalcinosis, y más raramente por la artritis séptica con gérmenes lentos como las micobacterias. La algodistrofia también tiene una presentación clínica inflamatoria, aunque no se acompaña de inflamación en los exámenes de laboratorio. Las patologías mecánicas están representadas por la artrosis, radiocarpiana o rizartrosis; las lesiones óseas, principalmente del escafoides y del semilunar, y las lesiones ligamentosas, la tendinitis y los quistes sinoviales. Aparte de las urgencias, el tratamiento médico se basará en el reposo mediante el uso de una ortesis, el alivio del dolor si es necesario mediante analgésicos o antiinflamatorios por vía tópica o sistémica y, a veces, la infiltración de cortisona. El reumatismo inflamatorio crónico debe someterse rápidamente a un tratamiento de fondo. Las lesiones óseas y/o ligamentosas y sus consecuencias también requieren un tratamiento especializado.

Il polso è particolarmente esposto a lesioni traumatiche, microtraumi e patologie infiammatorie. Un buon approccio clinico, una radiografia standard e un’ecografia sono sufficienti per stabilire una diagnosi nella maggior parte dei casi. L’artrite acuta, settica o microcristallina è un’emergenza. Se sussiste il minimo dubbio su un’artrite settica, il paziente deve essere indirizzato urgentemente a una struttura in grado di effettuare prelievi batteriologici prima di qualsiasi terapia antibiotica. Le patologie di andamento infiammatorio sono rappresentate dai reumatismi infiammatori cronici, in particolare l’artrite reumatoide, le artriti microcristalline e soprattutto la condrocalcinosi, e più raramente da artriti settiche da germi lenti come i micobatteri. L’algodistrofia ha anch’essa una presentazione clinica infiammatoria sebbene non sia accompagnata da un’infiammazione biologica. Le patologie meccaniche sono rappresentate dall’artrosi, radiocarpale o rizoartrosi, dalle lesioni ossee, principalmente dello scafoide e del lunato, e legamentose, dalle tendiniti e dalle cisti sinoviali. Al di fuori dei casi di emergenza, il trattamento medico sarà basato sul riposo mediante l’uso di ortesi e sul sollievo se necessario del dolore mediante analgesici o farmaci antinfiammatori per via locale o sistemica, talvolta mediante infiltrazione cortisonica. I reumatismi infiammatori cronici devono essere trattati prontamente. Anche le lesioni ossee e/o legamentose e le loro conseguenze richiedono delle cure specialistiche.

Background: The cause of recent onset polyarthritis can be difficult to identify. Objective: To determine which laboratory and imaging studies French rheumatologists recommend, not taking cost into account, for the [...]

El hueso debe adaptar constantemente su estructura y su capacidad de resistencia a las solicitaciones mecánicas. Un desequilibrio entre las tensiones aplicadas al hueso y su resistencia mecánica puede conducir a las denominadas fracturas «por sobrecarga», no traumáticas. Las fracturas por fatiga se observan principalmente en el entorno militar o deportivo. Se ven favorecidas por una actividad inadecuada (demasiado intensiva, con un equipamiento no óptimo) en un contexto favorable (sexo femenino, cualidades esqueléticas previas menos buenas, aporte energético insuficiente, etc.). La prevención a través de la detección y la corrección de estos factores resulta crucial. Las fracturas por insuficiencia ósea se producen sobre una osteopatía fragilizante (la osteoporosis es la más frecuente) y pueden constituir su primera manifestación.

Las osteoartropatías nerviosas son lesiones destructivas osteoarticulares regionales potencialmente graves que pueden provocar deformaciones, inestabilidad, úlceras cutáneas e incluso amputaciones. Se producen en el curso de trastornos sensitivos (propioceptivos, nociceptivos y disautonómicos) de origen periférico, como en la diabetes, o central. En la actualidad, la diabetes ha sustituido a la sífilis como principal causa, seguida de las lesiones medulares postraumáticas y la neuropatía hereditaria. Esta afectación sensitiva explica el carácter relativamente indoloro de la enfermedad. Por lo general, se afecta una sola región, con mayor frecuencia el pie y/o el tobillo, con menor frecuencia la rodilla, el hombro, la columna vertebral; otras localizaciones son muy poco frecuentes. La fisiopatología implica, por una parte, un microtraumatismo favorecido por la ausencia de percepción del dolor y, por otra parte, una desmineralización favorecida por la hiperemia secundaria a la perturbación de la circulación local. Se pueden distinguir dos fases. En la fase aguda, la articulación está caliente, hinchada, enrojecida; las radiografías, inicialmente normales, muestran después desmineralización, erosiones articulares, fracturas y fragmentaciones de los huesos, y deformaciones. Hay una hipercaptación gammagráfica regional inespecífica. La resonancia magnética muestra un edema óseo y de tejidos blandos precoz, fracturas, derrames articulares y destrucción. El síndrome inflamatorio es moderado o está ausente. En esta fase, los diagnósticos diferenciales son la artritis, la algodistrofia y, sobre todo, la osteomielitis. Luego, el calor y el edema disminuyen de forma progresiva, y las lesiones radiológicas se organizan más, dando paso a las secuelas definitivas. Por lo tanto, el tratamiento debe ser muy precoz. En la fase aguda, debe prescribirse la descarga completa o parcial de peso, junto con el uso de una ortesis. La utilidad de los bifosfonatos no está claramente establecida. La reanudación progresiva del apoyo con calzado ortopédico se autoriza cuando el edema y el calor de la piel se han normalizado, después de varias semanas. La cirugía tiene por objetivo corregir las secuelas funcionalmente molestas (úlcera o amenaza de úlcera, trastorno estático que impide el calzado, inestabilidad). Globalmente, se asocia con altas tasas de fracaso y complicaciones.

The media and social networks often echo fears about the potential toxicity of cosmetics and the dangers they pose to the environment. Dermatologists may be asked about these topics, but despite regulatory labelling constraints and the proliferation of specialized sites and applications, they do not always have access to reliable information. It is for this reason that we are providing the present overview of current knowledge on the subject.

Non-steroidal anti-inflammatory drugs, such as aspirin, are the medications of choice in treating patients with osteoarthritis. The effectiveness of drug therapy may be assessed by patients' subjective perceptions of pain diminution or by other more objective criteria. Analysis of locomotion, or the pattern of walking, can determine the extent of disability caused by arthritis and can be used to objectively assess any improvement mediated by treatment. Gait analysis was used to assess the effectiveness of naproxen, a non-steroidal anti-inflammatory drug, in 11 patients with osteoarthritis, aged 49 to 69. After one week of treatment, significant changes in gait were observed, including increased speed, stride length, swing velocity, and decreased stride duration, duration of support on both legs, and stance duration. Similar changes occurred in gait pattern during fast walking. Two patients who had walked dissymmetrically, an indicator of mechanical dysfunction, regained symmetrical gait with naproxen treatment. Pain relief, assessed by the patients, improved significantly, but was not correlated with changes in gait patterns. The findings suggest that objective assessment of drug therapy, such as gait analysis, is as important as pain assessment in determining the best treatment for patients with arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cell surface proteins of Gram-positive bacteria play crucial roles in their adhesion to abiotic and biotic surfaces. Pili are long and flexible proteinaceous filaments known to enhance bacterial initial adhesion. They promote surface colonization and are thus considered as essential factors in biofilm cohesion. Our hypothesis is that pili mediate interactions between cells and may thereby directly affect biofilm formation. In this study, we use single-cell force spectroscopy (SCFS) to quantify the force of the homotypic pili interactions between individual bacterial cells, using different Lactococcus lactisstrains producing pili or not as model bacteria. Moreover the force–distance curves were analyzed to determine the physical and nanomechanical properties of L. lactispili. The results for pili-devoided strains showed a weak adhesion between cells (adhesion forces and work in the range of 100 pN and 7 × 10–18J, respectively). On the contrary, the piliated strains showed high adhesion levels with adhesion forces and adhesion work over 200 pN and 50 × 10–18J, respectively. The force–extension curves showed multiple adhesion events, typical of the unfolding of macromolecules. These unfolding force peaks were fitted using the physical worm-like chain model to get fundamental knowledge on the pili nanomechanical properties. In addition, SCFS applied to a L. lactisisolate expressing both pili and mucus-binding protein at its surface and two derivative mutants revealed the capacity of pili to interact with other surface proteins including mucus-binding proteins. This study demonstrates that pili are involved in L. lactishomotypic interactions and thus can influence biofilm structuring.

Membrane fouling is one of the most investigated topics in the field of membrane processes because it is the main weakness that prevents membrane bioreactors (MBRs) from being widely applied. With a view to reduce membrane fouling, all the phenomena involved in the operation are worth understanding through a fine-tuned and deep examination. In the present paper, the study focused on the hydrodynamics in an air-lift MBR with a flat sheet membrane, taking into account the application of a specific method for biofouling mitigation adding free-moving particles in addition of bubbles injection. The application of this technique creates a complex three-phase gas–liquid–solid contactor in the MBR in terms of hydrodynamics. Therefore, the main objective of this work was to properly characterize, using a Particle image velocimetry (PIV) technique, such a system in order to clarify the potential effect of the addition of free-moving solid particles on the hydrodynamics and the performances of the MBR. Three different shapes of particles have been tested: beads, hollow cylinders, and flat sheets. Local hydrodynamic parameters, such as the liquid velocity, the liquid shear stress, or the bubble sizes and velocities, were analyzed with and without the presence of solid particles. Specific conclusions are drawn to help future users of this antifouling technique to optimize the design of the solid particles.

The presence of a pre-existing or recent extra-hepatic solid tumor was considered for a long time as an absolute contraindication to liver transplantation, by fear of futility with an unacceptable increase in non-liver-related mortality. However, cancer-related mortality in solid malignancies is heterogeneous, and experts suggest that case-by-case multidisciplinary decisions should be made. Here, we report the cases of 3 patients with favorable oncological and liver outcome in patients with renal cell carcinoma detected during pre-transplant evaluation that nonetheless underwent liver transplantation.

Background: Anti-Jo-1 autoantibodies represent essential markers in the diagnosis of antisynthetase syndrome (ASS). In this retrospective study, we aimed to investigate whether their concentrations and fluctuations could both respectively reflect the severity and evolution of ASS. Methods: Between 2015 and 2020, clinical and biological features of ASS patients with at least one positive measure of anti-Jo-1 autoantibody were collected. At each serum sampling, we assessed myositis activity by using the Myositis Intention to Treat Activities Index (MITAX) and compared anti-Jo-1 concentrations with ASS severity, anti-Jo-1 concentrations between patients with and without active disease, and changes in anti-Jo-1 concentrations with disease activity. Results: Forty-eight patients with ASS had at least one positive determination of anti-Jo-1 concentration. Among them, twenty-nine patients had at least two determinations of anti-Jo-1 autoantibody in their follow-up. We showed that these autoantibody concentrations were significantly correlated with MITAX (r= 0.4, p= 0.03) and creatine kinase concentration (r= 0.34, p= 0.002) and that they were significantly higher in patients with active disease than in those with inactive disease (91.7 IU/L vs 44.4 IU/L, p= 0.016). During follow-up, we found a significant correlation between fluctuations of anti-Jo-1 autoantibody concentrations and MITAX score (r= 0.7, p< 0.0001). Conclusion: Our results suggest that anti-Jo-1 autoantibody concentration could be a predictive marker of the severity and evolution of ASS and show that their quantification could represent a precious tool for disease monitoring and for improving the therapeutic management of ASS patients.

We demonstrated a class of highly nonlinear hybrid waveguide structures based on infiltration of As_2S_3 chalcogenide glass into silicon slot waveguides. The nonlinear properties of the hybrid waveguides were precisely quantified via a bidirectional top-hat D-scan method, enabling a direct comparison between properties measured using different device geometries. We experimentally demonstrate hybrid As_2S_3-Si slot waveguides with a two-photon absorption (TPA) figure of merit exceeding 2 at near infrared wavelengths. These waveguides largely satisfy the critical criterion for efficient nonlinear integrated photonics (FOMTPAwg>1), allowing phase shifts greater than π with minimal overall losses. These results pave the way for efficient and robust ultrafast all-optical devices and circuits in large-scale silicon photonics technology.

Sanitizers, disinfectants, and cleaning agents are vital to food hygiene assurance and are a major public health protection measure. Limiting microbial antibiotic resistance is also a global public health priority. Although many factors contribute to the rise in antimicrobial resistance in bacteria infecting humans, antibiotic use in both human clinical settings and for food-producing animals are primary contributors. Some concerns have been raised about the possibility of coselection between food hygiene chemicals and reduced antimicrobial susceptibility. This article reviews available evidence from individual studies purporting to demonstrate a possible risk of antimicrobial resistance development, following biocide usage. Furthermore, the conclusions of several key expert reports and meta-analysis publications were assessed for supportive evidence of a relationship between biocide usage in food production and resistance development. Although many studies report on the isolation of antimicrobial-resistant bacterial strains in food, evidence is lacking on the attribution of this resistance to biocide usage. Also, although a theoretical risk of causality exists, many of the studies performed to demonstrate this are in vitro studies using laboratory-grown or -trained bacterial isolates, challenged with sublethal (below the recommended food industry) disinfectant or sanitizing agent concentrations. The proper use of, and adherence to biocide manufacturer's instruction for use, and the avoidance of biocide active agent dilution (e.g., through biofilm presence) must be ensured in food production environments. It is recommended that in situ studies should be performed to further assess causality, ensured a clear differentiation between interpretation of stable antimicrobial resistance and phenotypic adaptation. Furthermore, authorization of new biocidal active substances should take a scientific and risk-based approach regarding the potential for driving microbial resistance.

Las micobacterias atípicas (MA) o micobacterias no tuberculosas son gérmenes ubicuos. Habitualmente no son patógenos para los humanos, pero pueden llegar a serlo a través de una inoculación directa o por causa de una inmunidad deficiente (situaciones como la diabetes, la infección por el virus de la inmunodeficiencia humana, un tratamiento inmunosupresor como los corticoides o los anti factor de necrosis tumoral o, de forma general, un contexto debilitado). La gran mayoría de infecciones por MA son pulmonares; con menor frecuencia, pueden localizarse en el aparato locomotor, en forma de artritis, tenosinovitis o bursitis sépticas, osteomielitis, espondilodiscitis o de infección de material ortopédico. Estas infecciones tienen en común una presentación clínica progresiva, con poco dolor y generalmente sin fiebre, con signos biológicos de infección inconstantes y a menudo moderados, lo que lleva a un retraso diagnóstico habitual, a menudo de varios meses o incluso años. La afectación suele ser destructiva con tendencia a la formación de abscesos. La presencia de granulomas gigantocelulares sin necrosis caseosa resulta sugestiva. Un diagnóstico bacteriológico preciso es la condición indispensable para el diagnóstico y, sobre todo, para un tratamiento eficaz. Este diagnóstico bacteriológico es delicado y requiere un laboratorio avezado y técnicas de cultivo y biología molecular específicas. Lamentablemente, a menudo, esto no se produce sino después del fracaso de un primer tratamiento con muestras estándar y una antibioticoterapia empírica que reducirá las posibilidades de aislar el germen. El tratamiento no está codificado y deberá adaptarse a cada situación. El principio general consiste en combinar la cirugía de escisión y la antibioticoterapia. Ésta debe incluir obligatoriamente varias moléculas que se adecúen al resultado del antibiograma (la sensibilidad variable de cada especie y las numerosas resistencias hacen que el tratamiento empírico sea ilusorio o, incluso, perjudicial) y debe ser prolongado (por lo general al menos de 6-12 meses o incluso más tiempo, especialmente si la infección es grave, el paciente está inmunodeprimido y no se ha practicado cirugía asociada). Es importante conocer estas características para poner en marcha un tratamiento adecuado, que se basa en la estrecha colaboración entre el reumatólogo o el internista, el traumatólogo, el especialista en enfermedades infecciosas y el laboratorio de bacteriología.

Pt and Pd electrocatalysts are active for the complex 8-electron borohydride oxidation reaction (BOR), but the completeness of the electrochemical reaction is compromised by the formation of byproducts, including unreacted H2. We probe how combining the two electrocatalysts might improve the overall BOR activity. Five catalyst layer compositions are compared by rotating disk electrode (RDE) voltammetry and as the anode in hydrogen-peroxide direct borohydride fuel cells (H2O2-DBFCs): Pt/C, Pd/C, a Pt/C + Pd/C mixture, and graded layers of Pt/C and Pd/C as Pt/C|Pd/C or Pd/C|Pt/C. The RDE results show distinct mechanistic pathways for Pt and Pd, electrodes, but that the mixtures and Pt/C|Pd/C graded electrodes lead to better BOR activity than Pt or Pd alone. Similarly, the graded anodes in H2O2-DBFC outperform the ones with pure Pt/C or Pd/C under several operational conditions due to synergy between Pt and Pd. The Pt and Pd appear to serve as cooperative electrocatalysts, with their combination leading to less deleterious H2 escape than cells with Pt-only electrodes, and higher electrochemical performance than cells with Pd-only electrodes. We conclude that catalyst layers with graded compositions are promising electrode architectures for DBFCs.

Windhoek, the capital of Namibia, is located in a semi-desert region, a long way from the sea and from its main surface water and groundwater sources. The city's population (a significant proportion of which lives in informal settlements) is growing. It has however been successful in meeting the water needs of its citizens, and has done so by working on several different fronts. Admittedly, part of the city's water supply is brought in from dams located some distance away from the city and, as is fairly conventional, these supplies supplement local groundwater sources. These resources are insufficient however, a problem that the City of Windhoek (CoW) has strived to address by reducing water demand on the one hand and increasing supply sources on the other. One of the major innovations is the use of dual wastewater reuse loops. In the first place the city has a reticulation system providing treated wastewater for the needs of parks and gardens. After been blended with treated surface water and sent to the city's drinking water system, a large part of this treated wastewater is used to provide drinking water however. The surplus water from rainy years is then injected into the underlying aquifer to ensure a backup supply source for dry years. In this way, as much as one quarter of the city's water needs is provided through wastewater reuse loops. Other valuable insights are to be gained from the analysis of social and cultural contingencies and their impact on the viability of water supply projects.

We study whether the borohydride oxidation reaction (BOR) on Pt is improved when the Pt is supported on tantalum oxyphosphate-Vulcan carbon (Pt/[TaOPO4/VC]). Pt on carbon (Pt/C) is unstable in the alkaline conditions at the fuel cell anode. The support is employed to improve stability, and mitigate poisoning of the Pt from BOR intermediates. BOR measurements on the Pt/[TaOPO4/VC] by rotating disk electrode (RDE) voltammetry show that the Pt/[TaOPO4/VC] is more poison-resistant than Pt/C when the NaBH4 concentration is high (0.10 M). The Pt/[TaOPO4/VC] is also incorporated at the anode of a hydrogen peroxide direct borohydride fuel cell (H2O2-DBFC). At NaBH4 anode concentrations of 0.1 M NaBH4, the DBFCs with Pt/[TaOPO4/VC] anodes have higher specific activity than those with Pt/C, particularly at 60oC.

La littérature récente décrit des potentiels facteurs mécaniques dans le développement et l’aggravation de l’ostéonécrose de la tête fémorale (OTF), mais ceci n’a pas été confirmé par des études mécaniques spécifiques. Aussi nous avons mis au point un modèle 3D par éléments finis à partir de données in vivo sur des patients souffrant d’OTF débutante afin de déterminer si la zone de nécrose se superposait à celle des contraintes maximales au niveau de la tête fémorale.

Si, quantitativement, la forêt affecte souvent négativement le bilan hydrologique en saison sèche, ses effets sont globalement bénéfiques à la protection de la qualité de l’eau. Les arbres servent d’abord de filtre atmosphérique, et sont donc un réceptacle des pollutions et dépôts atmosphériques. Ces pollutions tendent alors à fluer vers les sols. Elles sont intégrées dans la biomasse, fixées dans les sols, et une partie percole dans le sous-sol. Il en résulte une modification plus ou moins forte de la qualité de l’eau rejoignant les nappes souterraines et alimentant les cours d’eau. Mais les arbres améliorent notablement la structuration des sols et la capacité de ces derniers à filtrer et à stocker les matières en suspension, polluants et minéraux. Par ailleurs, la présence des forêts s’accompagne de faibles activités humaines polluantes comme les activités industrielles, agricoles et urbaines au sens large. Il est vrai que l’exploitation forestière peut conduire à certaines pollutions (transport solide, ajout de pesticides, flux temporaires de minéraux et nutriments…), mais ces pollutions potentielles sont modérées comparativement à celles des autres activités humaines, car les activités sylvicoles sont moins fréquentes et généralement moins perturbatrices. On peut donc conclure que la présence des forêts assure souvent un rôle de protection de la qualité des eaux superficielles ou souterraines qui y transitent (en limitant leur contamination, voire en servant de zone tampon dans certains contextes spécifiques), avec une eau souvent de meilleure qualité sous un sol forestier que sous un autre type de sol. Cela ouvre la porte à des synergies entre les activités forestières et les fonctions et usages de l’eau situées en aval. C’est notamment le cas des captages d’eau potable. Comme les bonnes pratiques sylvicoles ont un coût, il convient de rechercher la mise en oeuvre d’un paiement pour service environnemental par les acteurs bénéficiant de ces services.

La baie des Veys, située en Normandie (France), est le lieu d’un nombre important de parcs conchylicoles. Cette activité économique est à la merci de pollutions bactériennes ponctuelles issues du bassin versant, qui peuvent alors rendre potentiellement les coquillages impropres à la consommation, et donc nuire à leur commercialisation. Le bassin versant de 3500 km2comporte quatre grandes rivières (Vire, Aure, Douve, Taute), ainsi que des petits cours d’eau cÔtiers. Une étude complète a été réalisée afin d’identifier dans quel contexte il y a des risques de contamination importante des parcs conchylicoles, d’où proviennent les bactéries correspondantes, et de définir un plan d’action à mettre en oeuvre pour y remédier. Cette étude s’est appuyée sur une double modélisation des flux bactériens (Escherichia coli), consistant en un modèle terrestre sur le bassin versant jusqu’aux exutoires en mer, et un modèle marin, les sorties du premier modèle étant les entrées du second. Ces modèles ont pris en compte les sources d’émission, le routage et la mortalité bactérienne dans les rivières et en mer. Le modèle terrestre a été calé sur la base de campagnes de mesures en été et en hiver. La modélisation a ensuite été utilisée pour tester des scénarios climatiques (avec différentes conditions de vent, de marée, de pluie et de température) et des scénarios de pollutions accidentelles ou prospectifs. Cette modélisation permet de lier les contaminations principales des parcs conchylicoles aux sources d’émission (sous-bassins versants agricoles, rejets de station d’épuration, rejets pluviaux urbains…), et constitue donc un outil de premier ordre pour un plan d’actions ciblées. Il est en outre utilisable comme outil de gestion active en cas de pollution accidentelle. Les pluies et les portes à flots apparaissent avoir un effet majeur sur les bilans des flux bactériens arrivant en mer.

La directive cadre européenne sur l’eau (DCE) vise la reconquête de la qualité des milieux aquatiques et impose la réduction, voire la suppression, de nouveaux polluants (tels que les hydrocarbures aromatiques polycycliques, les pesticides, les métaux) de nos eaux dans les années à venir. Depuis une dizaine d’années, la construction d’ouvrages de génie écologique, utilisant les services écosystémiques et les mécanismes existants en zones humides, est une solution de traitement pouvant répondre aux exigences réglementaires de la DCE. Ces espaces aménagés entre la station de trai tement des eaux usées et le milieu récepteur, appelés zones de rejet végétalisées (ZRV), ne sont pas considérés aujourd’hui comme faisant partie du dispositif de traitement. Actuellement, les ZRV existantes sont très hétérogènes et il n’existe pas de règles de conception ni de dimensionnement permettant de garantir des fonctionnalités épuratoires et le développement d’une biodiversité. Le projet Zone Humide ARTificielle (ZHART) avait pour finalité de développer et d’industrialiser de nouvelles ZRV assurant des garanties d’élimination des micropolluants, mais aussi de protéger la diversité écologique, et d’en favoriser l’intégration paysagère. Dans ce but des audits hydrauliques, épuratoires et écologiques mais aussi d’insertion territoriale ont été effectués sur plusieurs ZRV. Les résultats ont permis de confirmer le potentiel épuratoire des ZRV ayant un temps de séjour supérieur à un jour. Toutefois, ils mettent également en évidence une grande hétérogénéité de performance entre sites, entre substances, ainsi que pour une même substance sur différentes ZRV, ce qui confirme le besoin d’une conception et d’un dimensionnement adaptés pour garantir des performances de traitement par les ZRV. Grâce au développement d’un modèle biologique, le concept de ZRV composée d’habitats typiques des milieux humides a été confirmé. Cette spécificité permet de favoriser les voies d’élimination des polluants et la colonisation d’espèces inféodées à ces milieux. L’étude d’insertion sociale et territoriale des ZRV a mis en évidence la nécessité d’identifier dès l’amont d’un nouveau projet les principaux enjeux locaux.

The direct electrooxidation of sodium borohydride (NaBH4) provides a path to release the high energy of the 8-electron, multi-step borohydride oxidation reaction (BOR). In practice, no single electrocatalyst is known to effectively oxidize all steps of the reaction. We investigate whether more complete BOR is achieved using an anode with a mixed electrocatalyst of nanoparticulate Pt and/or Pd supported on carbon (noted Pt/C and Pd/C). Electrocatalysts are compared in a liquid flow-through hydrogen peroxide direct borohydride fuel cell (H2O2-DBFC) having single Pt/C or Pd/C electrocatalyst, a mixture, or a gradient of the two along the anode flow channel. The best performance and lowest impedance over a broad range of potentials comes from a graded catalyst in which the composition varies from Pd/C at the channel inlet to Pt/C at the outlet, suggesting that catalyst gradients might provide a path to more efficient fuel cells for flow-type reactant systems.

Objective.Enthesitis is the spondyloarthritis (SpA) landmark, but can also be seen after entheses overuse, such as during intensive sport.Methods.We aimed to compare entheses ultrasound (US) findings in a prospective cross-sectional study of 30 axial SpA cases, 30 athletes, and 29 controls.Results.Mean (SD) MAdrid Sonographic Enthesis Index (MASEI) score was 26.3 (13), 12.2 (7), and 10.4 (6) in patients with SpA, athletes, and non-athlete control groups, respectively (p < 0.0001).Conclusion.The MASEI score was significantly higher in patients with SpA compared with healthy controls, athletes, and non-athletes, and can be of value to distinguish SpA from healthy subjects, whatever their physical activity.

Les villes de Singapour et de Windhoek sont emblématiques d’une recherche d’efficacité dans la gestion de l’alimentation en eau, car elles sont toutes deux confrontées à une insuffisance de leurs ressources hydriques propres. Ces deux villes subissent des contraintes environnementales, politiques, sociales et économiques différentes, et leur politique hydrique est aujourd’hui citée en exemple par de nombreux observateurs. On peut dès lors engager un parallèle entre ces deux approches à la fois similaires et différentes, analyser l’impact des actions mises en oeuvre pour résoudre la dépendance hydrique et identifier certains des effets directs et indirects sur la durabilité du service d’eau.

More and more cities are dealing with the concurrent trends of water scarcity and growth in water demand. It has thus become imperative to find alternative resources. Both Singapore and Windhoek – two very different cities in terms of the context in which they have to provide water and the options available to them – have addressed this problem by developing efficient operational solutions for supplying water to their populations. It is therefore instructive to compare their approaches, similarities and differences as a means of identifying the possibilities that might be put to use elsewhere in the world. Water reuse, rainwater harvesting, dual reticulation systems, limitation of water losses, and water saving policies are some of the solutions identified as having the potential to significantly improve the water balance in cities. In practice, one quarter of the water used in Singapore and Windhoek is derived from recycled wastewater. In Singapore, most of this reclaimed water is used for industrial needs, whereas in Windhoek, it is used for drinking purposes. However, other potential problems need to be addressed such as energy consumption and the population's ability to pay for their water supply. Indeed, in Singapore, the energy consumption for water production is on the rise, mainly on account of the treatment processes used, and it is imperative to halt this trend. In Windhoek, on the other hand, a critical issue – potentially affecting the sustainability of the water supply system – is the population's ability to pay. There is every indication therefore that water reuse may be part of the solution for supplying water in water-stressed contexts. A comparative study of the urban water cycles in Windhoek and Singapore sheds light on the importance of addressing the issue of water reuse within a framework that is broader than a strictly technical approach. Closing the water loop is always undertaken along with water demand reduction policies combining education, information and financial incentives, and with urban planning and land use control in order to protect water resources and expand storage capacities.

Dans un contexte de croissance du coût de l’énergie, de stress hydrique, et une décroissance des capacités d’investissement des autorités publiques, la gestion centralisée des cycles de l’eau en ville, qui prévalait jusqu’à présent, est désormais remise en cause. Tant par leur impact sur l’environnement que par leurs performances économiques, les systèmes décentralisés sont de plus en plus mis en avant comme solution alternative. La cohabitation prévisible de ces deux concepts doit être abordée, et l’état transitoire entre la situation actuelle et un système multiforme et adaptatif à différentes échelles constitue une période critique. L’un des objectifs du projet Syracuse est d’évaluer la viabilité de ces systèmes composites, et d’identifier les combinaisons sociotechniques optimisant les cycles de l’eau en ville compte tenu des infrastructures existantes.L’évaluation de boucles courtes doit être portée en regardant à la fois la viabilité économique, environnementale, et sociétale, et en tenant compte des objectifs recherchés. Ces objectifs sont multiples et comportent la réduction des consommations d’eau potable et des prélèvements sur les ressources naturelles, et la réduction de l’impact environnemental des cycles urbains de l’eau. Par ailleurs, la viabilité de telles boucles courtes dépend de plusieurs facteurs comme le niveau de stress hydrique, le climat, la topographie, l’hydrologie, l’hydrogéologie, l’urbanisme, l’acceptabilité sociale, les aspects institutionnels, économiques et les contraintes de maintenance…Dans un tel contexte de dépendance envers le contexte local, la viabilité de ce nouveau concept doit être évaluée à différentes échelles et à différents endroits. Pour cela, le projet Syracuse étudie en 2013 et 2014 dix cas d’études représentatifs de contextes climatiques, géographiques, urbains et institutionnels variés. Leur analyse permettra de définir dans quels cas et dans quelles conditions les nouveaux cycles peuvent être développés.

ABSTRACTOsteoarticular infection is an uncommon presentation of Q fever. Positron emission tomography (PET) scanning is a valuable tool for the diagnosis of Coxiella burnetiigraft prosthesis infection and endocarditis. Our objective was to test a series of culture-negative osteoarticular samples using molecular assays for Coxiella burnetii. We tested for C. burnetiiby molecular assays targeting the IS1111and the IS30Aspacer regions, using culture-negative osteoarticular samples obtained in our laboratory between January 2011and December 2012. We examine a total of 1,410 osteoarticular samples, and we observed two cases of arthritis and subacromial bursitis caused by C. burnetii. The infections were localized using PET scanning, and the diagnosis was confirmed through serology. For one, a C. burnetiistrain with a multispacer sequence type 8 genotype was isolated from synovial fluid culture. Q fever articular infections could be undiagnosed because of the long evolution of articular attack, and patients with high antibody titers against C. burnetiishould be tested using PET scanning to localize the site of infection.

This work concerns the separation of a mixture of bi-dispersed spherical micro-particles by lateral migration at moderate Reynolds numbers. The expected differential focalization on annular rings of particles flowing in a circular micro-channel according to their size could be of interest for separation processes of poly-dispersed bio-particles suspensions. We propose an original and simple experimental method to study fluorescent particle migration at the microscale which is based on an indirect visualization of their position in a micro-channel. The particles are harvested on a plane filtration membrane put perpendicularly at the outlet of the channel. Their distribution on the membrane is then observed by fluorescent microscopy. A numerical simulation (COMSOL Multiphysics®) was developed to study the influence of membrane permeability and channel/membrane relative positions on the flow streamlines and on the subsequent size of the annular ring formed on the membrane by the focused particles. First experiments have been performed with suspensions of 1 and 4.8 μm diameter particles in order to correlate their positions to experimental conditions.

Objective.To evaluate the efficacy and safety of rituximab (RTX) in several subsets of spondyloarthritis (SpA) using the data of the AIR (Autoimmunity and Rituximab) registry.Methods.All patients receiving RTX for SpA, and prospectively included in the AIR registry from September 2005 to September 2010, were retrospectively analyzed. The response to treatment was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index for axial disease, joint count for peripheral disease, and C-reactive protein reduction.Results.Among the 595 patients included in the AIR registry, 26 patients with SpA from 13 centers were reported: ankylosing spondylitis (10), undifferentiated SpA (7), and psoriatic arthritis (9). Mean disease duration was 8.8 years (range 1−40). The extraarticular features found were psoriasis, 12 cases; uveitis, 4 cases; and Crohn’s disease, 3 cases. The mean number of disease-modifying antirheumatic drugs before RTX was 2.4; previous anti-tumor necrosis factor (TNF) agents were taken in 23 cases. The mean number of RTX courses was 1.5 (range 1−5), with a total of 35.6 patient-years. Efficacy was noted in 11/23 cases: 3 out of 3 anti-TNF-naive patients and 8 out of 20 anti-TNF nonresponder patients. No predictive factors of response could be identified, particularly in diagnosis subsets or clinical presentation (axial or peripheral).Conclusion.In this nationwide study of several subsets of SpA, RTX had only a moderate efficacy that was more marked in patients who were anti-TNF-naive.

Background: Anterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). We aimed to assess and compare the incidence of AU in axSpA patients treated with anti-TNF or anti-IL17A. Methods: We systematically reviewed PubMed, EMBase, and Cochrane from inception to May 3, 2020, and searched for placebo-controlled and head-to-head randomized controlled trials (RCTs) assessing anti-TNF monoclonal antibodies (mAb) or soluble receptor fusion protein or anti-IL17A in patients with axSpA according to ASAS criteria and reporting safety data on AU. Data were extracted following a predefined protocol. We did pairwise and network meta-analyses for the primary outcome of AU flares (relapse or de novo) incidence and estimated summary odds ratios (ORs). We assessed the quality of evidence using the Cochrane risk-of-bias 2.0 tool. We ranked treatments according to their effectiveness in preventing AU flare using the P-score. Results: We identified 752 citations and included 33 RCTs, comprising 4544 treated patients (anti-TNF mAb 2101, etanercept [ETN] 699, anti-IL17A 1744) and 2497 placebo-receiving patients. Incidence of uveitis was lower with anti-TNF mAb versus placebo (OR = 0.46; CI 95% [0.24; 0.90]) and versus anti-IL17A (OR = 0.34; CI 95% [0.12; 0.92]. According to the P-score, the ranking from the most to the least preventive treatment of uveitis flare was as follows: anti-TNF mAb, ETN, placebo, and anti-IL17A. Conclusion: In RCTs assessing anti-TNF and anti-IL17A in axSpA, incident uveitis are rare events. However, this network meta-analysis demonstrates that anti-TNF mAb are associated with a lower incidence of uveitis compared to placebo and anti-IL17A.

The article discusses the effects of climate change into the life of the indigenous people in the Pacific island country of Vanuatu. The author stated that the first official climate change refugees are the residents of Lateau, a coastal village on the island of Tegua, when rising seas swamp into their houses in December 2006. He added that due to the environmental phenomenon, the government has moved the community to higher ground inland and the people have to make fundamental changes to survive in the new location since much of their lives are tied to their original village site.

ABSTRACTThe excision of the staphylococcal chromosomal cassette mec(SCCmec) from methicillin-resistant Staphylococcus aureus(MRSA) strains results in methicillin-susceptible S. aureus(MSSA) strains. In order to determine the proportion and diversity of multidrug-resistant MSSA (MR-MSSA) strains derived from MRSA strains, 247 mecA-negative isolates recovered in 60 French hospitals between 2002 and 2004 were characterized. The spatypes of all strains were determined, and a subset of the strains (n= 30) was further genotyped by multilocus sequence typing. The IDI-MRSA assay was used to test the isolates for the presence of the SCCmecelement, which was detected in 68% of all isolates analyzed. Molecular analysis of the samples suggested that 92% of the MR-MSSA isolates were derived from MRSA clones of diverse genetic backgrounds, of which the clone of sequence type 8 and SCCmectype IVAaccounted for most of the samples. High variations in incidence data and differences in the molecular characteristics of the isolates from one hospital to another indicate that the emergence of MR-MSSA resulted from independent SCCmecexcisions from epidemic MRSA isolates, as well as the diffusion of methicillin-susceptible strains after the loss of SCCmec. MR-MSSA could constitute a useful model for the study of the respective genetic and environmental factors involved in the dissemination of S. aureusin hospitals.

A photo essay which depicts the Mount Hagen festival held in August 2007 in the highlands of Papua New Guinea is presented.

OBJECTIVE: To conduct a practice survey of laboratory and imaging studies used by French rheumatologists to identify the cause of recent-onset arthritis. METHODS: We selected a random sample of 210 rheumatologists, who were asked to recruit all patients with recent-onset arthritis (at least one joint involved, for less than one year) during a 2 week period, and to record laboratory and imaging studies performed. Results were analyzed in the overall group, in diagnostic subgroups, and in clinical presentation subgroups. RESULTS: The 119 rheumatologists who participated recruited 104 patients. Investigations done in >= 75% of patients were blood cell counts; erythrocyte sedimentation rate; serum assays of C-reactive protein, rheumatoid factors, antinuclear antibodies; and hand radiographs. Investigations in 50% to 74% of patients were serum ASAT/ALAT, creatinine, and uric acid; and foot radiographs. Finally, 25% to 49% of patients were tested for proteinuria; antikeratin antibodies; hepatitis B, hepatitis C, and Lyme serologies; creatine phosphokinase; blood iron; HLA-B27; and radiographs of chest and pelvis. No differences were found between investigations in patients with suspected rheumatoid arthritis and/or undifferentiated arthritis and those in other patients. In contrast, suspected diagnoses and presence of extraarticular manifestations classically associated with specific diseases modified the selection of investigations. CONCLUSION: Although considerable variability occurred, our study suggests that a limited panel of laboratory and imaging studies is performed in at least 25% of patients with recent-onset arthritis, regardless of clues suggesting a specific diagnosis.

BACKGROUND Methotrexate and nonsteroidal antiinflammatory drugs are frequently coadministered in the treatment of rheumatoid arthritis (RA).OBJECTIVE To evaluate the effect of lumiracoxib, a novel cyclooxygenase-2 selective inhibitor, on methotrexate pharmacokinetics and short-term safety in patients with RA.METHODS This multicenter, randomized, double-blind, placebo-controlled crossover study enrolled 18 patients (mean age 49.1 y) with stable RA. Patients were randomized to receive methotrexate 7.5–15 mg orally once weekly plus either lumiracoxib 400 mg/day or placebo for 7 days. Patients then received the other treatment combination for an additional 7 days. Serial blood and urine were collected for 24 hours after the methotrexate dose on day 1 (methotrexate alone) and days 8 and 15 (combination treatment).RESULTS Plasma methotrexate pharmacokinetics (AUC0–t, maximum concentration [Cmax], time to Cmax) and methotrexate protein binding were similar for methotrexate alone (108.0 ng•h/mL, 26.7 ng/mL, 1.5 h, and 57.1%, respectively), methotrexate/lumiracoxib (110.2 ng•h/mL, 27.5 ng/mL, 1.0 h, and 53.7%, respectively), and methotrexate/placebo (101.8 ng•h/mL, 22.6 ng/mL, 1.0 h, and 57.0%, respectively). Similarly, no clinically significant difference was found in the urinary excretion of methotrexate. Mean exposure to the 7–OH metabolite was lower when methotrexate was given with lumiracoxib compared with placebo, shown by a reduction in AUC and Cmax, although similar amounts of the metabolite were recovered in urine following both lumiracoxib and placebo. Coadministration of methotrexate and lumiracoxib was well tolerated.CONCLUSIONS Lumiracoxib had no significant effect on the pharmacokinetics, protein binding, or urinary excretion of coadministered methotrexate in patients with RA.

ObjectiveTo evaluate the costs of workups to diagnose early arthritis.MethodsIn 2000, the French Society for Rheumatology conducted a survey of a representative sample of French and Belgian rheumatologists n 239. The respondents were asked to consider 2 hypothetical scenarios, 1 describing undifferentiated arthritis and the other more suggestive of rheumatoid arthritis. They were then asked what diagnostic workup they would order. Costs for each study were determined in 2001 euros, according to the French public health system fee schedules.ResultsIn total, 151 rheumatologists participated in the study 63. The mean ± SD diagnostic costs were 406.5 ± 194.3 € for the case with no diagnostic clues, and 280.7 ± 154.3 € for the case suggestive of early RA. Responses were very heterogeneous. The 2 main sources of expenditure were immunology tests and imaging. Hospital staff physicians tended to order more expensive workups, and costs tended to vary inversely with physician experience. The most important predictor of cost was diagnostic doubt, as estimated by the number of diagnoses proposed by respondents in each case; each additional diagnosis cost an additional 19.1–26.1 €.ConclusionDiagnostic workups after a first medical visit for early polyarthritis result in substantial direct costs. This observation and the great variability observed in physicians practices point out the need for consensus on the appropriate workups for these patients.

A membrane bioreactor (MBR), an association of a bioreactor with a crossflow filtration unit, enables continuous processes with total cell retention within the reactor to be realized. Provided that high dilution rates can be applied and that inhibition processes are avoided, very high biomass concentrations can be reached, thereby improving the volumetric productivities. These membrane bioreactors have been successfully applied to various microbial bioconversion, such as alcoholic fermentation, solvents, organic acid production, starters, and wastewater treatment. On the basis of the biological reaction characteristics and bibliographic results, the potentialities and bottlenecks of this methodology are discussed. Depending on the application, it is shown how the performance of the membrane bioreactor can be enhanced by acting either on the biological reaction achievement, by controlling the balance between cell growth and death, or on the dilution rate, by increasing the permeate flux through the filtration unit. This discussion is based on results obtained in specific biological treatments applied to polluted liquid and gas.