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A thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty technique has not been reported. To report the outcomes on sexuality, urinary function, satisfaction, and regrets following SPP performed at our centre. All consecutive patients who underwent the three-step technique of pre-expanded SPP between 2007 and 2018 and who had at least one year of follow-up. Questionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self-Esteem And Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery patient-reported outcome measures (USS-PROM) questionnaire. A total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures, and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3 cm (standard deviation [SD] 2.6), and the mean girth was 11.8 cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item lower urinary tract symptom score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%). Pre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall, sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position. [ABSTRACT FROM AUTHOR]

Bacteria of the Pseudomonas putida group are studied for a large panel of properties ranging from plant growth promotion and bioremediation to pathogenicity. To date, most of the classification of individual pseudomonads from this group relies on 16S RNA gene analysis, which is insufficient for accurate taxonomic characterization within bacterial species complexes of the Pseudomonas putida group. Here, a collection of 20 of these bacteria, isolated from various soils, was assessed via multi-locus sequence analysis of rpoD , gyrB and rrs genes. The 20 strains clustered in 7 different clades of the P. putida group. One strain per cluster was sequenced and results were compared to complete genome sequences of type strains of the P. putida group. Phylogenetic analyses, average nucleotide identity data and digital DNA hybridizations, combined to phenotypic characteristics, resulted in the proposition and description of four new species i.e. Pseudomonas alloputida Kh7 T (= LMG 29756 T = CFBP 8484 T) sp. nov. , Pseudomonas inefficax JV551A3 T (= DSM108619 T = CFBP 8493 T) sp. nov. , Pseudomonas persica RUB6 T (= LMG 29757 T = CFBP 8486 T) sp. nov. and Pseudomonas shirazica VM14 T (= LMG 29953 T = CFBP 8487 T) sp. nov. [ABSTRACT FROM AUTHOR]

Abstract: With the deinstitutionalization and the evolution of antipsychotic therapeutics, the life of psychotic women has changed. If issues related to desire, questioning and sexual life are globally similar to those of general population, this sexuality is more active with multiple sexual partners, with more unwanted and unplanned pregnancies, abortion, and sexual abuses. A review of literature reveals that limited published research exists on the subjective experiences of mothers with a psychotic illness and their desire for child. Furthermore, pregnancy of mentally-ill patients raises ethical questions for professionals who look after these women because of the illness, their environment, the social conditions of life, and their isolation. The desire of pregnancy does not fully coincide with the desire of a child. Some psychotic women want to be pregnant but do not want a child. Other women cannot establish a mother–child link because the imaginary child overrides the real baby. But, on the contrary, some are very good mothers, especially in the first months of life of the baby. How must we work with this desire of pregnancy with our psychotic patients to understand and to help them, and in order to ameliorate the preventive strategies of protection for the child in case of pregnancy? [Copyright &y& Elsevier]

Abstract: More than 50% of suicides are by patients who have been or are still followed-up. The prevalence of suicidal crises is high (32%) and stable in populations of chronic psychiatric patients. Suicidal risk factors are well known, nevertheless they are more particularly high during acute crises and are lower when the psychiatric illness is chronic. Five percent of the suicides are committed during hospitalization. Most of them occur on the first month following admission, in the first week of an acute psychotic crisis, within the year after hospitalization, prior to the hospital discharge. The rate of suicide is particularly important in psychiatric institutions because most of their patients are suffering from schizophrenia and/or depression, two diseases with high rates of suicide. Some suicidal risk factors specific to schizophrenia have been identified such as the schizoid-affective form of the disease, patient care that has been delayed, a chronic disease with numerous acute episodes, short and frequent admissions in a hospital, involuntary hospitalisations, extrapyramidal side effects and disruption of treatment. The vulnerability appears to be maximum during the first week and/or the three months after discharge from the hospital, during the first year following the diagnosis and during acute episodes, especially the first one. In the second part of this work, we will examine the legal aspects, based on the main recent court cases relative to hospital liability. The fault usually consists in lack of surveillance and involves the liability of the hospital. The assessment of the adequacy of the measures taken for the medical care of a patient and in particular his/her supervision depends on the predictability of the suicidal act; the severity of the psychiatric illness and more particularly on previous suicidal attempts; previous fugues from the hospital and previous violent acting out especially on the occasion of previous hospitalisations. To avoid reciprocal projections when there is a suicidal act it is essential to work with family and attendants, to obtain clear and exact information about the psychiatric illness and to ensure both medical and administrative care. [Copyright &y& Elsevier]

Abstract: In case of disease and trauma some patients draw back upon denial to endure a reality that is unacceptable, i.e. that cannot be assimilated in the psychic sphere. The denial is a phenomenon of the patient refusing to recognise parts of reality. But what is denial? A symptom? A defensive psychotic mechanism? In clinical cases we are regularly confronted with different forms of “denial”, emanating from multiple psychopathologic elaborations. What psychiatric situations lead us to talk about “denial”? Is it always the same regardless of the circumstances of the situation? After defining denial, we have tried to approach its function in different cases of schizophrenia, personality disorder, pregnancy and somatic diseases with the help of clinical cases. According to E. Lancon, the verb “denier” appears in the French language about 1160 in the form of “denier” derived from the latin “denegare”. In modern French, “denier” expresses the fact: i) of refusing to admit or to recognise a fact or an assertion as true or as one''s own, or, expressed differently to refuse to recognise the relation with someone else; ii) of refusing to give somebody an IOU. Appearing in the 13th century with the general meaning of “an action to refuse something to somebody”, the obligatory). After the 17th century, it means to deny a fact. In modern language, it is used in a more restricted sense and mainly in legal expressions. “Dénégation” from the Latin “denegatio” is a late 14th century loan of a legal expression that means rejection. In the first place, it describes a situation when a person maintains that a fact reported by another one is not true. At the end of the 18th century, it is the refusal to recognise a fact. Nowadays, the expression is defined by the fact of negation or denial. In French literature, denegation is used more frequently than denial. In psychiatry, denial represents a reactive, defensive and unconscious mechanism used by a subject confronted with an invasion of anxiety as a reaction to trauma or disease. It is present in certain paradoxical situations where a normal personality is overtaxed by a major traumatic event that generates cracks and discontinuities in the tissue of this psychic reality. Otherwise, in the structures of more pathological personalities such as sexual perverts or borderline personalities, denial is associated with “cleavage” (split). In this case, denial does not affect the global perception of reality. Thus we can say that denial is a psychodynamic mechanism that may appear in any patient to allow him to maintain his integrity and his somatopsychic homeostasis as long as reality or parts of reality cannot be accepted. In psychosis, denial concerns large areas of reality allowing persons not to confront the anguish of annihilation. Denial appears in the silence and the lack of relation with the others. Denial is massive in paranoiac or schizophrenia pathologies. In this way, denial presents a scale of distinctive graded denials. Each degree of denial finds its corresponding level in a determined psychopathological organisation. This organisation is graduated from psychosis to perversion. The expression “denial” is used very frequently in psychiatry, sometimes in the description of clinical cases, or otherwise to show the difficulties of institutional treatment. It is used as rag-bag expression that underlines the inability of the care giver to deal with a patient who does not allow any communication. [Copyright &y& Elsevier]

Le programme de réhabilitation amélioré (PRA) permet réduire les complications postopératoires et la durée du séjour hospitalier. Les conclusions de plusieurs méta-analyses montrent également qu'une immunonutrition périopératoire en chirurgie digestive oncologique réduit les complications postopératoires et la durée du séjour, mais cela reste controversé. Sur ces données les sociétés savantes recommandent l'association PRA et prescriptions d'une immunonutrition préopératoire 7 jours avant la chirurgie. Cependant, l'association de l'immunonutrition avec un programme de PRA est mal étudiée et mal définie. Cette étude a évalué l'impact de l'immunonutrition préopératoire sur les complications postopératoires en chirurgie colorectale programmée dans le cadre d'un PRA. Nous avons inclus tous les patients enregistrés du 30-01-2017 au 08-01-2020 dans la base de données prospective nationale de GRACE (groupe francophone pour la réhabilitation améliorée après chirurgie). Les patients recevant une immunonutrition préopératoire (IN +) et ceux n'en recevant pas (IN −) ont été comparés à l'aide du score de propension (PS) et d'une régression logistique pondérée sur le score PS. Le critère de jugement principal était les complications postopératoires à 30 jours et les critères de jugement secondaires étaient les complications chirurgicales, médicales et infectieuses à 30 jours et la durée du séjour. Les résultats sont exprimés en pourcentage, médiane et écart interquartile, comparaison par OR (IC95 %) et pour la durée de séjour avec HR (IC95 %). Au total, 5701 patients inclus (56,53 % d'hommes) dont 4045 IN+ : âge : 69 (61–77) ans ; IMC : 25,3 (22,6–28,5), 15,7 % des patients dénutris ; ASA 3–4 : 85 % ; chirurgie rectale : 34,9 % ; laparotomie : 23 %. Les groupes étaient similaires sauf pour le type de chirurgie (chirurgie rectale (34,7 % vs 32,5 %, p : 0,014). Taux de complications à 27,98 % (n = 1595), durée de séjour : 6 jours. Les 2 groupes sont comparables sauf pour le type de chirurgie (chirurgie rectale : 34,7 % vs 32,5 %, p : 0,014). Dans le groupe IN+, sans et avec PS, les complications postopératoires, infectieuses, et chirurgicales étaient significativement plus élevées avec respectivement après PS (OR : 1,170 [1,76–1,271] p < 0,001), (OR : 1,227 [1,072–1,405] p < 0,003), (OR : 1,156 [1,064–1,256] p < 0,001) et la durée de séjour significativement plus longue (OR : 0,897 [0,864–0,931)] p : 0,015). Les complications médicales n'étaient significativement pas différentes entre les 2 groupes (OR : 0,947 [0,832–1,078] p : 0,410). Avec tous les biais dus à ce type d'étude, dans des conditions de vie réelle, chez des patients non sélectionnés, l'immunonutrition préopératoire en chirurgie colorectale oncologique élective dans le cadre d'un PRA n'a apporté aucun bénéfice supplémentaire voire a été associée à plus de complications. Il apparaît indispensable d'étudier de manière plus approfondie cette association pour savoir si elle est pertinente. [ABSTRACT FROM AUTHOR]

To compare the occurrence of healthcare-associated infections acquired in intensive care units (HAI-ICUs) in France among patients with COVID-19 and those without it in 2020 and the latter with that in patients before the COVID-19 pandemic. Multicentre HAI-ICU surveillance network (REA-REZO) data were used to identify 3 groups: 2019 patients (2019Control), a COVID-19 group (2020Cov), and a non–COVID-19 group (2020NonCov). The primary outcome was the occurrence of HAI-ICU (ventilator-associated pneumonia [VAP], bloodstream infections [BSIs], catheter-related bacteraemia). Standardized infection ratios of VAP were calculated for each quarter in 2020 and compared with those in 2019. A total of 30 105 patients were included in 2020: 23 798 in the 2020NonCov group, 4465 in 2020Cov group, and 39 635 patients in the 2019Control group. The frequency of VAP was strikingly greater in the 2020Cov group: 35.6 (33.4–37.8) episodes/1000 days of mechanical ventilation versus 18.4 (17.6–19.2) in the 2020NonCov group. VAP standardized infection ratio was high in 2020 patients, particularly during the 2 quarters corresponding to the 2 waves. BSI/1000 days were more frequent in the 2020Cov group (6.4% [6.4–6.4%] vs. 3.9% [3.8–3.9%] in the 2020NonCov group). VAP and BSI were also more frequent in the 2020NonCov group than in the 2019Control group. The microbial epidemiology was only slightly different. The data presented here indicate that HAI-ICUs were more frequent during the COVID-19 period, whether the patients were admitted for COVID-19 or, to a lesser extent, for another cause. This implies that managing patients with severe disease in a pandemic context carries risks for all patients. [ABSTRACT FROM AUTHOR]

Abstract: Post-partum psychosis occurs in one to two cases out of 1000 deliveries. Studies in prenatal psychiatry have improved our understanding of the symptoms. If the prognosis of the acute state is generally positive, the rate of recidivism remains important due to the risk of becoming chronic. Analysis of the data allows preventative work with mothers-to-be. From a psychodynamic perspective, pregnancy is a time of important psychological conflicts, identity crisis and awakening of infantile conflicts. The understanding of those psycho-emotional mechanisms related to pregnancy and the multidimensional approach appears to be indispensable in taking care of acute psychiatric post-partum states. The case of Mrs. O, hospitalised in adult psychiatrics for a post-partum manic episode shows how those theoretical models become relevant in order to elaborate intra-psychological conflicts. The anamnesis and the history of the patient revealed the existence of several risk factors for triggering the psychosis. The identification of the patient to her maternal lineage in association with revisiting her infantile past grounded the psychosis. We worked the issue of her place within her maternal lineage, with her husband and her place as a mother. The confusion about her own identity added to the patient''s generational confusion was gradually amended and a work of separation/individuation could then be undertaken. [Copyright &y& Elsevier]

Fluorescent pseudomonads from bean root and rhizosphere in Iran were investigated for biocontrol of the fungal pathogen Rhizoctonia solani . Phylogenetic analysis of concatenated 16S rRNA, gyrB and rpoD sequences for 33 Pseudomonas isolates showed that 15 belonged to four clusters within the ‘ P. fluorescens ’ group, i.e. one corresponding to P. thivervalensis , two others including P. moraviensis or P. baetica , and the last one without closely-related established species. The 18 other isolates belonged to five clusters within the ‘ P. putida ’ group, one including P. mosselii and P. entomophila , another including strains currently described as P. putida , and three without closely-related species described. Ten isolates were selected based on in vitro inhibition of R. solani . Cellulase activity was identified in three pseudomonads, chitinase activity in two pseudomonads, extracellular protease activity in nine pseudomonads and hydrogen cyanide production in two pseudomonads. Genes coding for production of phenazine, pyoluteorin, pyrrolnitrin and 2,4-diacetylphloroglucinol were not found, whereas the 1-aminocyclopropane-1-carboxylate deamination gene acdS was present in three pseudomonads. The antagonistic acdS + strain VKh13 from the ‘ P. putida ’ group effectively protected soil-grown bean from R. solani AG 4-HGI. Results show that pseudomonads from uncharacterized taxa were readily obtained from Iranian soils and displayed biocontrol potential against R. solani . [ABSTRACT FROM AUTHOR]

Abstract: Aims. – Motor threshold (MT) is an important parameter for the practice of transcranial magnetic stimulation. Our goal was to compare three methods to estimate MT in a clinical setting. Methods. – Comparison of three MT estimation algorithms: 1) the Rossini-Rothwell method consists in lowering stimulus intensity until only five positive responses out of 10 trials are recorded, defining MT; 2) the Mills-Nithi method considers the MT as the mean of an upper threshold (10 positive out of 10 trials) and a lower threshold (0 out of 10 trials); 3) the supervised parametric method estimates the MT by fitting (mathematically and graphically) a sigmoid function on raw data obtained by stimulation at variable intensities. Six MT estimations (two per method) were recorded in a single session in 10 healthy subjects. Results. – The within-subject variation of MT (expressed as % of the mean MT±standard deviation) during a single session was of 8.5±7.2% for the Rossini-Rothwell method, 8.7±5.7% for the Mills-Nithi method and 9.5±4.0% for the supervised parametric method. No significant differences in variability of MT estimation were found between the methods, but the Rossini-Rothwell method was significantly shorter (half the number of stimuli compared to the two other methods). Conclusion. – In our setting, Rossini-Rothwell method was superior to the two other methods. The variability of MT estimation measured in our study is important, yet acceptable for clinical applications. However, this variability can be a source of considerable errors in excitability studies and should be a focus of future research. [Copyright &y& Elsevier]

The aim of the study was to establish a relationship between the clinical efficacy of risperidone (Risp), the biological levels of Risp and its metabolite, 9-hydroxyrisperidone (9-OH-Risp), and the turnover of blood biogenic amines during a long-term treatment (1 year). Risp is one of the newer atypical antipsychotic drugs with potent serotonin (5HT2), moderate D2 and real α1-α2 adrenoreceptor antagonistic effects. The study has been performed in an open setting and included 17 patients, but only 15 were followed-up from 3 to 12 months. Pharmacokinetic analyses were conducted at the same time as clinical evaluations, grading using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI), the Global Assessment of Functioning Scale (GAF), the Quality of Life Scale (QLS) and the Extrapyramidal Symptoms Rating Scale (ESRS) and the determinations of plasma and red blood cell (RBC) Risp and 9-OH-Risp, whole blood 5HT and tryptophan (Trp), plasma homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5HIAA) and dihydroxyphenylethyleneglycol (DHPG). The therapeutic drug monitoring needed oral Risp daily dose of 4.5±2.3 mg (range 2–8) and the stabilized concentrations (ng/ml) at endpoint in plasma and RBC were 10±8 (range 1–23) and 3.5±2 (range 1–8) for Risp and 29±19 (range 8–70) and 11.5±6.6 (range 2.6–22.5) for 9-OH-Risp, respectively. 9-OH-Risp appears to be the major active metabolite compound at higher concentrations than Risp. Positive linear correlations were found only between plasma and RBC 9-OH-Risp and the daily dose and the score of the GAF. Statistically significant clinical results showed that Risp is a potent antipsychotic agent efficacious both on positive and negative symptoms and on quality of life. Positive symptoms decreased after about the second month and the negative symptoms improved secondly. Patients (n=8) who responded to Risp were characterized, on the long-term, by a statistically significant decrease of whole blood 5HT and increase of plasma DHPG. [Copyright &y& Elsevier]

Noninvasive detection of restenosis in patients remaining asymptomatic after percutaneous transluminal coronary angioplasty (PTCA) remains a major clinical problem. The value of exercise electrocardiography (ECG) and exercise-redistribution thallium-201 single-photon emission computed tomography (SPECT) in detecting restenosis in such patients remains uncertain. Discordances between these tests and coronary angiography is a common situation. We studied 179 consecutive patients remaining asymptomatic after successful PTCA (208 vessels), who underwent 6 +/- 2 months of exercise ECG, SPECT, and coronary angiography. We sought to assess the diagnostic value of the noninvasive tests compared with coronary angiography, and identify the determinants of discordances between the tests. Restenosis (diameter stenosis >50%) was detected in 39% of patients and in 37% of vessels. The overall sensitivity, specificity, and accuracy for exercise ECG and SPECT in detecting restenosis in individual vessels were, respectively, 53% versus 63% (p = 0.06), 59% versus 77% (p = 0.0001), and 57% versus 72% (p = 0. 0001). On multivariate analysis, positive exercise ECG was associated with higher heart rate response (p = 0.02), incomplete revascularization (p = 0.004), and angiographic restenosis (p = 0. 03), whereas positive SPECT was associated with incomplete revascularization (p = 0.02), infarct-related artery PTCA (p = 0.01), and angiographic restenosis (p = 0.0001). Accuracies of the 2 tests were not significantly different in patients with incomplete revascularization or PTCA of an infarct-related vessel. Overall, SPECT is more accurate than exercise ECG in detecting asymptomatic restenosis. Nevertheless, incomplete revascularization and PTCA of an infarct-related artery could cause reversible perfusion defects regardless of restenosis, reducing the diagnostic value of SPECT in such patients. [ABSTRACT FROM AUTHOR]

Determines the influence of dialysis on in-hospital outcome after balloon angioplasty with stent or without coronary stenting and on one-year clinical outcome after coronary stenting or balloon angioplasty with residual stenosis. Clinical and angiographic baseline characteristics; Procedural outcomes and in-hospital complications.

To assess the effect of successful late coronary angioplasty of an occluded infarct-related artery on the prevalence of ventricular late potentials, signal-averaged electrocardiograms were recorded in 123 consecutive patients surviving a first acute myocardial infarction (58 with and 65 without mechanical reperfusion of the occluded coronary artery). Multivariate analysis showed that successful reperfusion by late angioplasty of the infarct artery contributes to a decrease in the prevalence of late potentials. [ABSTRACT FROM AUTHOR]