Search

The seven members of the A3 family of cytidine deaminases (A3A to A3H) share a conserved catalytic activity that converts cytidines in single-stranded (ss) DNA into uridines, thereby inducing mutations. After their initial identification as cell-intrinsic defenses against HIV and other retroviruses, A3s were also found to impair many additional viruses. Moreover, some of the A3 proteins (A3A, A3B and A3H haplotype I) are dysregulated in cancer cells, thereby causing chromosomal mutations that can be selected to fuel progression of malignancy. Viral mechanisms that increase transcription of A3 genes or induce proteasomal degradation of A3 proteins have been characterized. However, only a few underlying biological mechanisms regulating levels of A3s in uninfected cells have been described. Here, we characterize that the von Hippel–Lindau tumor suppressor (pVHL), via its CRL(pVHL), induces degradation of all 7 A3 proteins. Two independent lines of evidence supported the conclusion that the multi-protein CRL(pVHL) complex is necessary for A3 degradation. CRL(pVHL) more effectively induced degradation of nuclear, pro-cancer A3 (A3B) than the cytoplasmic, anti-retroviral A3 (A3G). These results identify specific cellular factors that regulate A3s post-translationally.

Arterial cannulation is an important procedure for hemodynamic monitoring and blood sampling. Traditional radial artery cannulation is performed by using anatomical knowledge and pulse palpation as a guide. Arterial cannulation using ultrasound (US) requires specific training, especially for new US users. We hypothesized that even for new US users, US guidance would facilitate the successful puncture by lower attempts before successful intraluminal cannulation of a simulation model of the radial artery.A prospective randomized controlled crossover study was conducted with new US users on a gelatin phantom wrist. Three sessions of training were proposed: US-guided technique with low blood pressure (BP), palpation-guided technique with high BP, and one secondary comparison with low BP. For the 2 first sessions, all volunteers performed each technique but not in the same order. The main criterion was the number of attempts before successful catheterization of the model artery. A secondary criterion was the number of needle movements (the number of attempts plus the number of needle directional changes).Twenty new US users participated in the study. Numbers of attempts before successful catheterization were significantly lower when using the US technique: 1.1 (± 0.4) for US versus 1.6 (± 0.8) for palpation high BP (US technique was more successful than traditional palpation technique for novice US users performing arterial cannulations for the first time. A study in the clinical practice is needed to confirm these results.

Bibliographie: Clerc, Isabelle/Fritschi, Tobias/Gurtner, Andrea/Richard, Tina: Editorial zum Schwerpunktthema: Soziale Nachhaltigkeit und Diversity & Inclusion: Ubereinstimmungen und Widerspruche, ZDfm – Zeitschrift fur Diversitatsforschung und -management, 2-2021, S. 121-123. https://doi.org/10.3224/zdfm.v6i2.01 ----- Open-Access-Lizenz: Dieser Beitrag ist ab dem 23.11.2021 im Open Access unter der Creative-Commons-Lizenz CC BY 4.0 (Namensnennung 4.0 International) verfugbar. Weitere Informationen zur Lizenz und den Nutzungsbedingungen finden Sie hier .

None

Summary Background Few studies of mental health or substance abuse have focused on rural life. This study aimed to evaluate the association between socio-demographic and clinical characteristics and the probability of rural alcoholic women seeking help on their own at a specialty treatment service. Methods This exploratory study used a cross-sectional design to collect data from alcoholic women upon admission to a French outpatient department. Multiple logistic regression models tested whether the socio-demographic and clinical characteristics of these women predicted the likelihood that they would seek treatment at a specialty service on their own. Results Among 50 rural alcoholic women, the probability of seeking help on their own at a specialty treatment service was 5.6 times greater (95% CI 1.2–25.7, P = 0.03) for participants with a history of physical and/or sexual trauma and 5.1 times greater (95% CI 1.1–24, P = 0.03) among women with no complementary health insurance. Conclusion Increased knowledge of the specific characteristics of rural alcoholic women is needed to develop programs that will increase awareness of and access to specialty treatment services among these women.

Background & Aims We developed and validated a magnetic resonance imaging–based index to predict Crohn’s disease (CD) postoperative recurrence (POR). Methods Patients with CD who underwent a postoperative evaluation for recurrence (with colonoscopy and MRI no longer than 105 days apart) were included between 2006 and 2016 in University Hospital of Nancy, France. MRI items with good levels of intra-rater and inter-rater agreement (Gwet’s coefficient ≥0.5) were selected. The MRI in Crohn’s Disease to Predict Postoperative Recurrence (MONITOR) index’s performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and accuracy, by considering the Rutgeerts score as the gold standard. The MONITOR index was validated with a bootstrap method and an independent cohort. Results Seventy-three MRI datasets were interpreted by 2 radiologists. Seven items (bowel wall thickness, contrast enhancement, T2 signal increase, diffusion-weighted signal increase, edema, ulcers, and the length of the diseased segment) had a Gwet’s coefficient ≥0.5 and were significantly associated with the Rutgeerts score, leading to their inclusion in the MONITOR index. All the items had a weighting of 1, except the “ulcers” item weighting 2.5, reflecting the higher adjusted odds ratio. The AUROC [95% confidence interval] for the prediction of endoscopic POR (Rutgeerts score >i1) was 0.80 [0.70–0.90]. The optimal threshold was a MONITOR index ≥1, giving a sensitivity of 79%, a specificity of 55%, a predictive positive value of 68%, and a predictive negative value of 68%. The bootstrap validation gave an AUROC of 0.85 [0.73–0.97]. In the validation cohort, a MONITOR index ≥1 gave a sensitivity of 87%, a specificity of 75%, a predictive positive value of 84.6%, and a predictive negative value of 75%. Conclusions The MONITOR index is an efficient, reliable, easy-to-apply tool that can be used in clinical practice to predict the POR of CD.

This article investigates the plain language practices of professional writers in Quebec, using a survey. We contacted 55 professional writers and asked them to complete an online survey about how they apply plain language in their work, and the type of writing assistance they would find useful. We also asked 40 of those writers to carry out a simplification task to see what kind of simplifications they were actually making. If the feelings about the reality of the writers’ work is in line with the literature, opinions on plain language guidelines are not. Most writers in our survey find them useful and precise enough, and this contrasts with reported criticisms of such guides. In the simplification task, we noticed that writers focus on the overall understanding of the text, and not only on some linguistic characteristics (as shown in plain language guidelines). The more experienced the writer is, the more changes they will make to visual/structural aspects or relational efficiency. Putting the focus on the reader’s needs is their main concern. Cet article s’intéresse aux pratiques de rédaction claire des rédacteurs professionnels au Québec, par le biais d’une enquête. Nous avons contacté 55 rédacteurs professionnels et leur avons demandé de répondre à une enquête en ligne sur la manière dont ils utilisent le langage clair dans leur travail et sur le type d’aide à la rédaction qu’ils trouveraient utile. Nous avons également demandé à 40 de ces rédacteurs de réaliser une tâche de réécriture, pour voir quels types de simplification ils faisaient réellement. Si leur vision du travail d’un rédacteur professionnel est en accord avec la littérature, leurs opinions sur les guides de rédaction claire ne le sont pas. La plupart des rédacteurs interrogés les trouvent utiles et assez précis, ce qui contraste avec les critiques énoncées contre ces guides. Dans la tâche de réécriture/simplification, nous avons remarqué que les rédacteurs se concentrent sur la compréhension globale du texte, et pas seulement sur certaines caractéristiques linguistiques (comme présenté dans les guides de rédaction claire). Plus un rédacteur est expérimenté, plus il apportera des modifications aux aspects visuels/structurels ou influant sur l’efficacité relationnelle. Leur but principal est de remettre les besoins du lecteur au centre des préoccupations.

ZusammenfassungDigitale Transformation im Human Resource Management (HRM) bedeutet zunehmende Virtualisierung der Arbeit und Zusammenarbeit mit künstlicher Intelligenz, neuen personalen Anforderungen sowie erhöhter Mitarbeitendenmobilität. Resultate einer Mixed-Methods-Studie in einer von klein- und mittelständischen Unternehmen (KMU)s und öffentlichen Verwaltungen geprägten Region der Schweiz zeigen, dass trotz hoher Relevanz der digitalen Transformation in den befragten Betrieben die Qualifikation der Mitarbeitenden als noch nicht ausreichend betrachtet wird. Neben fachlichen Schulungen ausgewählter Skills werden persönlichkeitsbezogene Fähigkeiten (beispielsweise Offenheit und Flexibilität) und ein damit verbundenes Mindset bzw. eine entsprechende Organisationskultur als zentral erkannt. HRM ist allerdings noch stark mit der Digitalisierung der eigenen Prozesse beschäftigt und läuft damit Gefahr, die Chance zu verpassen, als strategischer Partner die Entwicklungen im Unternehmen hin zu neuen digitalen und flexiblen Organisationskulturen mitzugestalten.

International audience; Background: In patients with severe COVID-19, no data are available on the longitudinal evolution of biochemical abnormalities and their ability to predict disease outcomes.Methods: Using a retrospective, longitudinal cohort study design on consecutive patients with severe COVID-19, we used an extensive biochemical dataset of serial data and time-series design to estimate the occurrence of organ dysfunction and the severity of the inflammatory reaction and their association with acute respiratory failure (ARF) and death.Findings: On the 162 studied patients, 1151 biochemical explorations were carried out for up to 59 biochemical markers, totaling 15,260 biochemical values. The spectrum of biochemical abnormalities and their kinetics were consistent with a multi-organ involvement, including lung, kidney, heart, liver, muscle, and pancreas, along with a severe inflammatory syndrome. The proportion of patients who developed an acute kidney injury (AKI) stage 3, increased significantly during follow-up (0·9%, day 0; 21·4%, day 14; P250 iterations), only CRP >90 mg/L (odds ratio [OR] 6·87, 95% CI, 2·36-20·01) and urea nitrogen >0·36 g/L (OR 3·91, 95% CI, 1·15-13·29) were independently associated with the risk of ARF. Urea nitrogen >0·42 g/L was the only marker associated with the risk of COVID-19 related death.Interpretation: Our results point out the lack of the association between the inflammatory markers and the risk of death but rather highlight a significant association between renal dysfunction and the risk of COVID-19 related acute respiratory failure and death.

(1) Background: The progression of periodontitis, induced by polymicrobial dysbiosis, can be modified by systemic or environmental factors such as stress or anxiety affecting host response. The purpose of this study is to evaluate the potential associations between psychosocial factors scores or salivary cortisol levels with clinical periodontal parameters and bacterial environment in patients with periodontitis, (2) Methods: Subgingival microbiota was collected in two pathological and one healthy sites from thirty diseased patients (before/after scaling and root planing (SRP)) and from one healthy site from thirty control patients. Usual clinical periodontal parameters were recorded, and a saliva sample was harvested. Patients completed stress and anxiety self-assessment questionnaires. Cortisol concentrations were determined by ELISA and bacteria were identified by PCR, (3) Results: No correlation between salivary cortisol and the stress-anxiety self-declared was found (p &gt, 0.05), but high concentrations of this molecule were associated positively and linearly with periodontal pocket depth (p = 0.04). It appeared that certain psychosocial stressors are associated with a modulation of the bacterial colonization of pockets of diseased group (before/after SRP), notably concerning Tannerella forsythia (p = 0.02), Porphyromonas gingivalis (p = 0.03), Fusobacterium nucleatum (p = 0.049) and Campylobacter rectus (p = 0.01). (4) Conclusion: This study reveals associations between bacteria colonization and psychosocial parameters in periodontitis that needs to be further investigated.

Background In patients with severe coronavirus disease 2019 (COVID-19), data are scarce and conflicting regarding whether chronic use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) influences disease outcomes. In patients with severe COVID-19, we assessed the association between chronic ACEI/ARB use and the occurrence of kidney, lung, heart, and liver dysfunctions and the severity of the inflammatory reaction as evaluated by biomarkers kinetics, and their association with disease outcomes. Methods We performed a retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19. Independent predictors were assessed through receiver operating characteristic analysis, time-series analysis, logistic regression analysis, and multilevel modeling for repeated measures. Results On the 149 patients included in the study 30% (44/149) were treated with ACEI/ARB. ACEI/ARB use was independently associated with the following biochemical variations: phosphorus >40 mg/L (odds ratio [OR], 3.35, 95% confidence interval [CI], 1.83–6.14), creatinine >10.1 mg/L (OR, 3.22, 2.28–4.54), and urea nitrogen (UN) >0.52 g/L (OR, 2.65, 95% CI, 1.89–3.73). ACEI/ARB use was independently associated with acute kidney injury stage ≥1 (OR, 3.28, 95% CI, 2.17–4.94). The daily dose of ACEI/ARB was independently associated with altered kidney markers with an increased risk of +25 to +31% per each 10 mg increment of lisinopril-dose equivalent. In multivariable multilevel modeling, UN >0.52 g/L was independently associated with the risk of acute respiratory failure (OR, 3.54, 95% CI, 1.05–11.96). Conclusions Patients chronically treated with ACEI/ARB who have severe COVID-19 are at increased risk of acute kidney injury. In these patients, the increase in UN associated with ACEI/ARB use could predict the development of acute respiratory failure., The present retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19 provides new evidence on the potentially harmful effect of chronic ACEI/ARB use on kidney outcomes and their possible interaction with the occurrence of acute respiratory failure.

Cellular metabolism governs the susceptibility of CD4 T cells to HIV-1 infection. Multiple early post-fusion steps of HIV-1 replication are restricted in resting peripheral blood CD4 T cells; however, molecular mechanisms that underlie metabolic control of these steps remain undefined. Here, we show that mTOR activity following T cell stimulatory signals overcomes metabolic restrictions in these cells by enabling the expansion of dNTPs to fuel HIV-1 reverse transcription (RT), as well as increasing acetyl-CoA to stabilize microtubules that transport RT products. We find that catalytic mTOR inhibition diminishes the expansion of pools of both of these metabolites by limiting glucose and glutamine utilization in several pathways, thereby suppressing HIV-1 infection. We demonstrate how mTOR-coordinated biosyntheses enable the early steps of HIV-1 replication, add metabolic mechanisms by which mTOR inhibitors block HIV-1, and identify some metabolic modules downstream of mTOR as druggable targets for HIV-1 inhibition.

The objective of this study is to assess the prevalence, localization, and severity of bone erosions on radiography (RX) and ultrasonography (US) according to ACPA status in patients with rheumatoid arthritis (RA). 78 patients with ACPA-positive (ACPA+) RA and 30 patients with ACPA-negative (ACPA−) RA fulfilling the ACR 1987 and/or ACR/EULAR 2010 criteria were consecutively included. On RX, a modified Sharp erosion score (SHSe) was evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). On US, erosions were scored on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5) with a four-point scale to calculate the total US score for erosions (USSe). The mean total SHSe and USSe were 3.7 and 4.4 times higher in the ACPA+ group than in the ACPA− group, respectively (P

Cuff pressure gauges are the only recommended instrument to perform controls on endotracheal tube cuff pressure during anesthesia. No calibration is mandatory for these devices. The aim of this study was to describe the level of conformity of various cuff pressure gauges. The single-center measurements were performed with a cuff pressure calibrator on all cuff pressure gauges that were usually used in the operating room. Seven measurements (repeat three times) on each cuff pressure gauges at different levels of pressures (i.e. 0, 10, 20, 27, 30, 40 and 50 cmH2O) were performed. Our homologation criteria were either the reliability of the leak test (value of cuff pressure gauges maintained at 120 cmH2O during 5 s) or the difference between the values of the cuff pressure tested and the calibrator below 1.3 cmH2O at the range of 20-30 cmH2O. A total of 567 measurements on 27 cuff pressure gauges were performed. Only 30% (n = 8/27) of the cuff pressure gauges reach our homologation criteria. 30% (n = 8/27) failed at the leak test. 48% (n = 13/27) of the cuff pressure gauges tested, had a calibration variation error > 1.3 cmH2O on the levels of pressure between 20 and 30 cmH2O. A minority of cuff pressure gauges went through our homologation criteria. These results demonstrate us that there is a real problem of the reliability and the follow-up of those medical devices. This study suggests to reinforce biomedical engineering control on these devices.

Background & Aims Ulcerative colitis (UC) is increasingly recognized as a progressive disease and patients with long-standing disease can develop colorectal stricture. Few data about its incidence in UC are available, while risk factors for colorectal strictures in UC remain to be determined. We assessed the incidence of and risk factors for developing colorectal strictures in a large UC population. Methods All adult patients followed at Nancy University hospital and at the centre hospitalier de Luxembourg for UC, between January 2004 and July 2019, were eligible for inclusion in this multicenter retrospective cohort study. Results A total of 439 patients with UC were included. Median follow-up duration was 9.6 years. Incidence of colorectal stricture was 3.6%. The cumulative probability of developing this complication was 1% at 5 years and 2.3% at 10 years. Median age at stricture diagnosis was 47.9 years (41.0; 63.0), and median time from UC diagnosis to onset of stricture was 11.5 years (5; 15.3). Montreal A3 classification (age > 40 years) (P = .008) and steroids use (HR = 4.1; 95% CI, 1.1-16.1) were independent risk factors for stricture, whereas mesalamine-treated patients carried a lower risk (HR = 0.3; 95% CI, 0.1-0.9). Dysplasia was found in 6 patients with strictures (42.9%) and among them 5 developed a colorectal cancer (33.3%). Conclusions Patients with Montreal A3 classification and those exposed to steroids have a higher risk for strictures, while use of mesalamine lowers this risk. These factors should be assessed in daily clinical practice to prevent stricture occurrence in these patients.

Background There are currently no guidelines on the need to assess disease activity before stoma reversal in Crohn’s disease (CD). We sought to determine the value of cross-sectional imaging for detecting active CD before stoma reversal. Methods 38 CD patients underwent cross-sectional imaging before stoma reversal. CD activity was blindly evaluated by an independent radiologist. Postoperative outcomes were recorded. Results Before stoma reversal, cross-sectional imaging identified active CD in 20 of the 38 study participants (52.6%). In 9 out of 10 tested patients, radiologic and endoscopic assessments gave concordant findings with regard to CD recurrence before stoma reversal. Stoma reversal was delayed in half of the patients with active CD and in none of the patients without active CD. Before stoma reversal, tumor necrosis factor alpha antagonists or immunosuppressants were initiated in 45% of the patients with active CD and 5.6% of the patients without active CD. In the year following stoma reversal, the recurrence rate (in a radiologic assessment) was higher in patients with active CD than in patients without active CD (75.0% vs. 30.8%, respectively; p = 0.04). Conclusion Cross-sectional imaging revealed postoperative recurrence in about a quarter of patients before stoma reversal; this finding may influence the postoperative treatment strategy and outcomes.

Stéphanie Bourion-Bédès,1–3 Raymund Schwan,2 Paolo Di Patrizio,2 Guillaume Vlamynck,2 Sarah Viennet,2 Maxime Schvartz,2 Anne Gaunard,2 Alex Bédès,4 Isabelle Clerc-Urmès,5 Cédric Baumann3,5 1Regional Medical and Psychological Service (SMPR), 2CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), University Hospital of Nancy, 3EA4360 APEMAC, University of Lorraine, Nancy, 4ANPAA 15-CSAPA (Healthcare Center of Accompaniment and Prevention in Addictology), Saint-Flour, Cantal, 5Platform of Clinical Research Facility PARC, Unit MDS, University Hospital of Nancy, Nancy, France Background: Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. Methods: Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. Results: A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. Conclusion: The factors that affect patients’ ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes. Keywords: satisfaction, determinants, outpatient, substance dependence

Background Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients’ HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence. Methods HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients’ levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively). Results Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (β = 5.5; p = 0.001) and a lower baseline PCS score (β = − 0.6; p p = 0.02) was associated with less PCS change. Higher early satisfaction with care (β = 0.1; p = 0.02) and a lower baseline MCS score (β = − 0.7; p Conclusion The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients’ early satisfaction to identify areas of improvement and thus improve HRQoL.

to determine thresholds and better scenario for the diagnosis of erosive rheumatoid arthritis (RA) by ultrasonography (US) in RA in comparison to osteoarthritic (OA) patients.Patients, prospectively included, fulfilling ACR 1987; ACR/EULAR 2010 criteria for RA or hand OA criteria. Radiographic assessment (RX): Sharp erosion score, evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Definition of eroded RX RA: EULAR 2013 Definition. In US, erosions were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale.A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients have erosive diseases (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients have erosive diseases. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68 and 72.1%), specificities excellent (89.1 and 100%). With only six targeted joint facets examined (6/30), sensitivities and specificities remained good (59.8 and 60.0%) and excellent (95.6 and 100%) with threshold 1 and 2 respectively. For all scenarios, agreement between RX and US for erosive RA was excellent ranged from 88.1% to 92.8%.US erosion assessment of six targeted joint facets detected 1.7 times more erosive RA patients than RX in late and early RA with good sensitivity and excellent specificity.

The susceptibility of CD4 T cells to human immunodeficiency virus 1 (HIV-1) infection is regulated by glucose and glutamine metabolism, but the relative contributions of these nutrients to infection are not known. Here we show that glutaminolysis is the major pathway fuelling the tricarboxylic acid (TCA) cycle and oxidative phosphorylation (OXPHOS) in T-cell receptor-stimulated naive, as well as memory CD4, subsets and is required for optimal HIV-1 infection. Under conditions of attenuated glutaminolysis, the α-ketoglutarate (α-KG) TCA rescues early steps in infection; exogenous α-KG promotes HIV-1 reverse transcription, rendering both naive and memory cells more sensitive to infection. Blocking the glycolytic flux of pyruvate to lactate results in altered glucose carbon allocation to TCA and pentose phosphate pathway intermediates, an increase in OXPHOS and augmented HIV-1 reverse transcription. Moreover, HIV-1 infection is significantly higher in CD4 T cells selected on the basis of high mitochondrial biomass and OXPHOS activity. Therefore, the OXPHOS/aerobic glycolysis balance is a major regulator of HIV-1 infection in CD4 T lymphocytes.

Objective iBook on Antiphospholipid Syndrome (APS) did not exist before our work, and hence the utility of an Apple iBook as a teaching method in APS for medical students has never been assessed. Our objective was to evaluate medical students' improvement of knowledge and satisfaction with an interactive APS iBook, in comparison with conventional teaching methods. Methods An iBook designer with the guidance of a medical team developed the APS iBook in both French and English. Second-year medical students, naive of APS knowledge, were enrolled from two institutions. For the "teaching intervention", participants were randomly assigned to three groups: a) APS iBook with interactive capability; b) printed copy of the APS iBook material; and c) classroom lecture presentation of the APS iBook material by a physician-scientist experienced in APS. The participants filled a standardized medical questionnaire about APS before and after teaching interventions to determine the relative change of knowledge. Participants were asked to fill out a standardized satisfaction survey. After 20 weeks of the intervention, recall capability of students was tested. Results A total of 233 second-year medical students were enrolled (iBook group: 73; print group: 79, and lecture group: 81). Relative change of knowledge was not different between the iBook group and the printed material group; additionally, it was significantly higher in the lecture group than the two other methods. Satisfaction was significantly higher in both the lecture and the iBook groups than the print group, on several dimensions including overall quantitative satisfaction, subjective enhanced knowledge, interactivity, quality of content, comprehensibility, and pleasure of learning. Recall capability of students (n=109, 47%) was not significantly different among groups. Conclusion The APS iBook is as effective as printed material in improving medical student's knowledge, although a classroom lecture was the most effective method when compared to self-learning methods. Among self-learning methods, medical students are more satisfied with the APS iBook, whereas the recall capability was not different among groups. These results suggest that the APS iBook will help medical students in their curriculum and increase the awareness of APS among the community.

Resume Objectif La satisfaction vis-a-vis des soins est reconnue comme un indicateur de choix de la qualite des soins. L’objectif principal etait d’identifier des facteurs lies a la satisfaction precoce vis-a-vis des soins au 45e jour du debut de la prise en charge ambulatoire de patients dependants aux substances psychoactives de type alcool ou opiaces. L’objectif secondaire etait d’etudier la reproductibilite de la satisfaction au cours des soins. Methode Une etude longitudinale a ete realisee. La satisfaction a ete mesuree de maniere precoce aux 15e et 45e jours du debut des soins au moyen du questionnaire de satisfaction EQS-C. Les determinants de la satisfaction a j45 ont ete explores par des modeles de regression lineaire multivaries. La reproductibilite de la mesure j15/J45 a ete appreciee par un calcul du coefficient de correlation intraclasse. Resultats Au total, 189 patients ont ete inclus dont 90 ont repondu aux deux temps de mesure de la satisfaction. Le niveau de satisfaction precoce est eleve. Si l’absence d’antecedents de prise en charge de la dependance est associee a une meilleure satisfaction a j45 dans un premier temps (β = 6,8 ; p = 0,05), seul le score total de la satisfaction a j15 y est associe lorsqu’il est pris en compte (β = 0,7 ; p Conclusion Nous recommandons une mesure precoce a j15 de la satisfaction vis-a-vis des soins ambulatoires chez les patients dependants aux substances.

The aims of this study were to compare characteristics of radiography (RX) and ultrasound (US) erosive lesions in rheumatoid arthritis (RA) and osteoarthritis (OA) patients (prevalence, topography and severity), to determine thresholds for the diagnosis of erosive RA based on US and to evaluate the performance of US and RX to establish a diagnosis of erosive RA differentiated from hand OA.Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Erosions in US were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale to calculate total US score for erosions (USSe).A total of 168 patients were included: 122 RA (32 early RA 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to EULAR 2013 definition criteria with sensitivity at 34.4% and specificity at 89.1%. On US, 95 RA patients (21 early; 74 late) and 12 OA patients were eroded. Considering at least two joint facets eroded or at least one joint facet eroded at grade 2 on US, sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). Agreement between RX and US was excellent (90-92%). The positive and negative likehood ratios were respectively 3.16 and 0.73 for radiography and 6.64 and 0.31 for US (for two facets eroded).USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement.

Objectives Although nursing homes are thought to be significant reservoirs of antibiotic-resistant bacteria, very few large population-based studies comparing antibiotic resistance prevalence in nursing homes and in the community have adjusted for patient characteristics. Our objective was to compare the prevalence of antibiotic resistance of Enterobacteriaceae cultured from urine samples of nursing home residents with that of community-dwelling adults, all aged 65 years or older. Methods This study analysed around 20 000 positive urine samples sent to a large laboratory in north-eastern France from 2014 to 2017, collected from individuals aged 65 years or older. A multivariable logistic regression model adjusted for patient characteristics (gender, age, year of sampling, presence of urinary catheter and number of urine samples/year) compared the resistance of Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae to amoxicillin/clavulanate, nitrofurantoin, trimethoprim/sulfamethoxazole, nalidixic acid, ofloxacin, ciprofloxacin and ceftriaxone, as well as their possible EBSL production, in nursing home residents and community-dwellers. Results Nursing home residents had a higher adjusted OR (aOR) of Enterobacteriaceae (E. coli, P. mirabilis or K. pneumoniae) resistant to amoxicillin/clavulanate (aOR 1.38, 95% CI 1.27-1.50), ciprofloxacin (aOR 1.33, 95% CI 1.20-1.49) and ceftriaxone (aOR 1.37, 95% CI 1.15-1.63) or producing an ESBL (aOR 1.43, 95% CI 1.18-1.72), but did not differ in resistance to nitrofurantoin or trimethoprim/sulfamethoxazole. Conclusions Elderly people in nursing homes had a risk around 40% higher than their community-dwelling peers of having antibiotic-resistant Enterobacteriaceae cultured from their urine samples. Antibiotic stewardship and infection prevention and control programmes should be implemented in nursing homes.

In this article, we introduce a new Stata command to estimate the net survival function and the net cumulative hazard. The command includes graphic facilities. It was designed to have a similar syntax to sts, the Stata command dedicated to estimate survival and related functions. We present two examples to illustrate the use of this new command.

Online supplement. (DOCX 21 kb)