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Background Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking.Objectives Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN.Methods Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method.Results Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements.Conclusions We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.

BACKGROUND In line with evidence for a role of pathogenic TH2A in seasonal allergies, we previously showed that individuals suffering from food allergy exhibited a decrease in circulating TH2A cells following multi-food immunotherapy. Herein, we aim to confirm the decline of TH2A cells in individuals undergoing house dust mite immunotherapy (HDM-AIT) and extend our observation to a new subset of CD38 expressing activated TH2A cells. METHODS The frequencies of TH2A and CD38+ TH2A cells were analysed by flow cytometry in blood cells from 182 Japanese HDM-allergic individuals included in a 1-year clinical trial assessing the efficacy of HDM tablets. Interrelationship between these cellular responses and humoral mite-specific IgE and IgG4 levels was further explored. RESULTS A decrease in TH2A cells was observed in both active and placebo groups. Interestingly, CD38+ TH2A cell frequencies significantly decreased only in active groups. In younger individuals (16-30 years), both TH2A and CD38+ TH2A cells were significantly reduced in active groups but not in the placebo group. Significant inverse correlations were observed in the course of HDM-AIT between changes in TH2A or CD38+ TH2A frequencies and IgG4 antibody levels. CONCLUSIONS We confirm the value of monitoring TH2A cell frequencies in allergic individuals and extend this observation to perennial allergy to HDM. We highlight the interest of CD38 to better identify the subset of TH2A cell down-regulated by AIT. Finally, correlated cellular and humoral responses observed in immunoreactive individuals stress that coordinated pathways occur in the adaptive responses during AIT.

Background We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). Study Design and Methods French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. Results A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2–6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20–2.62, p Conclusion PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

BACKGROUND Whereas sublingual allergen immunotherapy (AIT) is routinely performed without any adjuvant or delivery system, there is a strong scientific rationale to better target the allergen(s) to oral dendritic cells known to support regulatory immune responses by using appropriate presentation platforms. OBJECTIVE To identify a safe presentation platform able to enhance allergen-specific tolerance induction. METHODS Virosomes with membrane-integrated contiguous overlapping peptides (COPs) of Bet v 1 and TLR4 or TLR2/TLR7 agonists were assessed for induction of Bet v 1-specific IgG1, IgG2a and IgE antibodies, hypersensitivity reactions and body temperature drop following subcutaneous injection in naive CD-1 mice. The most promising candidate, Bet v 1 COPs anchored to virosomes with membrane-incorporated TLR4 agonist (Vir.A-Bet v 1 COPs), was further evaluated by the sublingual route in a therapeutic setting in BALB/c mice with birch pollen-induced allergic asthma. Airway hyperresponsiveness, pro-inflammatory cells in bronchoalveolar lavages and polarization of Th cells in the lungs and spleen were then assessed. RESULTS Both types of adjuvanted virosomes coupled to Bet v 1 COPs triggered a boosted Th1 immunity. Given a more favourable safety profile, Vir.A-Bet v 1 COPs were further evaluated and shown to able to fully reverse asthma symptoms and lung inflammation in a sublingual therapeutic model of birch pollen allergy. CONCLUSIONS AND CLINICAL RELEVANCE We report herein for the first time on the capacity of a novel and safe presentation platform, that is virosomes with membrane-integrated TLR4 agonist, to improve dramatically sublingual AIT efficacy in a murine model due to its intrinsic dual properties of targeting and stimulating to further promote anti-allergic immune responses. As such, our study paves the ground for further clinical development of this allergen presentation platform for patients suffering from respiratory allergies.

3,4-Dihydroxy-6-[18F]-fluoro-l-phenylalanine (FDOPA) positron emission tomography (PET) is sensitive for identifying primary brain tumors. However, increased FDOPA uptake has been reported in pseudotumoral brain lesions. Our aim was to analyse FDOPA-PET in patients with pseudotumoral brain lesions and to compare them with patients with brain tumors. We retrospectively analysed consecutively recruited patients with suspected primary brain tumor (based on clinical and magnetic resonance imaging findings) referred for FDOPA-PET in our centre between November 2013 and June 2019 (n = 74). FDOPA-PET parameters (maximum and mean lesion standardised uptake values [SUV] and ratios comparing lesion with different background uptake SUV) and thresholds were evaluated to determine which offered optimal discrimination between pseudotumoral and tumoral lesions. Overlapping PET values were observed between pseudotumoral (n = 26) and tumoral (n = 48) lesion, particularly for low-grade tumors. Based on receiver operating characteristic (ROC) analyses, the optimal PET parameters to discriminate pseudotumoral from tumoral lesions were SUVmax lesion/basal ganglia, SUVmax lesion/grey matter, SUVmean lesion/grey matter, and SUVmax lesion/mirror area in contralateral hemisphere (all ratios showing area under the curve [AUC] 0.85, 95% CI). The narrowest 95% sensitivity–95% specificity window was observed for SUVmax lesion/basal ganglia ratio, with ratio values of 0.79 and 1.35 corresponding to 95% sensitivity and 95% specificity, respectively. FDOPA-PET uptake should be interpreted with caution in patients with suspected primary brain tumor, especially in patients showing low or intermediate SUV values and ratios. https://www.clinicaltrials.gov . Unique identifier: NCT04306484

In the context of a crisis situation or exceptional healthcare situation, and the activation of the white plan, the director of nursing and the paramedical teams are at the heart of the action in order to organise the continuity of care for patients and residents, notably in the case of a computer system failure resulting from a power outage.

International audience; An innovative approach based on superconcentration and granulation was investigated to manufacture dairy ingredients at lab-scale. A wet mass characterization technique, which measured agitator current consumption, was developed to study cohesiveness of super-concentrated products at various dry matter (DM) contents. For all ingredients, a composition-dependent cohesive phase was observed as DM increased, which was typified by a sharp rise and subsequent fall in power consumption. The effect of powder back-mixing on granulation was studied using three superconcentrate:powder (w/w) ratios (1:0.8, 1:1 and 1:1.2, respectively). Minimum powder addition rate for successful granulation was related to DM content at the end of the cohesive phase. Granulated powders had larger particle size, higher densities, lower porosities and enhanced flow properties compared to commercial spray-dried powders. The lab-scale model provided useful information on physical properties and limits during superconcentration and granulation, which increases the scientific knowledge relating to this novel powder production approach. Industrial relevance: Spray drying is the most widely utilized powder manufacturing technology in the dairy industry, especially for producing ingredients and nutritional products. It is, however, extremely energy intense and therefore spray drying of high-volume, low-value dairy streams such as permeate represents a poor use of resources for industry. An alternative spray dryer-free process has been developed for such streams, with significant savings. This process is based on superconcentration of streams to DM content in excess of what is typically seen in a spray-drying process (up to 80% w/w DM) followed by granulation achieved by back-mixing of finished product and, finally, drying of granules. However, little information is available on how various dairy ingredients behave in this system. Therefore, a novel lab-scale production model was produced to determine limits of superconcentration and granulation behavior of various ingredients. This work provides vital information and represents the first step in a larger program which will culminate in demonstration of the industrial applicability of the new approach for drying of various dairy streams.

With more than 12M tons of dairy powders produced each year at a global scale, the drying sector accounts to a large extent for the processing of milk and whey. It is generally considered that 40% of the dry matter collected overall ends up in a powder form. Moreover, nutritional dairy products presented in a dry form (eg, infant milk formulae) have grown quickly over the last decade, now accounting for a large share of the profit of the sector.Drying in the Dairy Industry: From Established Technologies to Advanced Innovations deals with the market of dairy powders issues, considering both final product and process as well as their interrelationships. It explains the different processing steps for the production of dairy powders including membrane, homogenisation, concentration and agglomeration processes. The book includes a presentation of the current technologies, the more recent development for each of them and their impact on the quality of the final powders. Lastly, one section is dedicated to recent innovations and methods directed to more sustainable processes, as well as latter developments at lab scale to go deeper in the understanding of the phenomena occurring during spray drying.Key Features: Presents state-of-the-art information on the production of a variety of different dairy powders Discusses the impact of processing parameters and drier design on the product quality such as protein denaturation and viability of probiotics Explains the impact of drying processes on the powder properties such as solubility, dispersibility, wettability, flowability, floodability, and hygroscopicity Covers the technology, modelling and control of the processing stepsThis book is a synthetic and complete reference work for researchers in academia and industry in order to encourage research and development and innovations in drying in the dairy industry.

International audience; Vacuum concentration is an intermediary step in the dairy powder production and an essential step in the process scheme for the production of sweetened concentrated milk, a product widely popular and produced in Brazil. As any food product, it is subject to research and development in order to improve the original recipe and propose new derivatives, whether in academic or industrial environments. The tests required for the development of products may be costly in relation to the supply in raw material and cleaning agents, energy and water consumptions as well as water treatment after the cleaning of the equipment. As part of the reduction of production costs and Vacuum concentration the present work aims to evaluate the possibility of using smaller equipment for concentration as well as to produce relevant data on the processing of SCM. Two types of vacuum evaporators were used for this work: a pilot scale falling film evaporator and a lab scale rotary evaporator. Based on the observed results, it was possible to evidence the similarity of the data obtained for the concentrates (with and without sucrose addition) in both equipment for the measurements of density, viscosity and surface tension with deviations less than 10%.

OBJECTIVE The pneumococcal urinary antigen test enables rapid bacteriological diagnosis in respiratory tract infections. The objective was to identify factors associated with a positive pneumococcal urinary antigen test result. PATIENTS AND METHODS This seven-year retrospective monocentric study was performed on consecutive patients presenting with respiratory tract infections reported as pneumococcal-positive. Epidemiological, biological, and radiological factors were analyzed, and severity scores were calculated. RESULTS A total of 223 patients were included. Significant associations were observed between positive test results and age over 65years (P=0.01), positive test results and immunosuppression factors (blood disease [25% Ag+ group vs. 4% Ag- group, P=0.001], immunosuppressive therapy [10% Ag+ group vs. 0% Ag- group, P=0.02]). Clinically, fever (64% Ag+ group vs. 42% Ag- group, P=0.01) and cough (46% Ag+ group vs. 19% Ag- group, P

Incorporation of elastomers into bioelectronics that reduces the mechanical mismatch between electronics and biological systems could potentially improve the long-term electronics-tissue interface. However, the chronic stability of elastomers in physiological conditions has not been systematically studied. Here, using electrochemical impedance spectrum we find that the electrochemical impedance of dielectric elastomers degrades over time in physiological environments. Both experimental and computational results reveal that this phenomenon is due to the diffusion of ions from the physiological solution into elastomers over time. Their conductivity increases by 6 orders of magnitude up to 10

Background: Endometrial cancer is the most common pelvic gynecological cancer in France. The most frequent symptom is post-menopausal bleeding and is one of the primary reasons for consultation in gynecological emergencies. The treatment is very codified and consists of a surgical intervention for anatomopathological analysis. The latter is frequently reassuring. These interventions are often performed in mild situations and there is currently no element to be sufficiently reassuring to avoid surgery. This study aims to explore the sensitivity of an innovative marker: Human Epididymis 4 (HE4) in the diagnosis approach of endometrial cancer in case of postmenopausal bleedings. Methods: This is a prospective multicenter diagnostic study with three centers involved. Inclusion criteria are any patient with post-menopausal bleeding who is to undergo hysteroscopy, endometrial biopsy, or endometrial resection. In accordance with the recommendations for the management of post-menopausal bleedings, the medical conduct consists of performing a clinical examination, an ultrasound and, in general, even in case of paraclinical examination reassuring, an anatomopathological analysis. This pathological analysis can be obtained in several ways: biopsy, hysteroscopy-curettage (which is the most frequently performed surgery), and hysterectomy. Our protocol consists of taking a blood sample from each woman who will undergo one of the interventions mentioned above. The dosage of HE4 and CA125 requires the withdrawal of an additional heparinized tube during the preoperative assessment usually performed. This research is therefore classified as non-interventional. The primary outcome is to evaluate the sensitivity of the HE4 marker in patients with postmenopausal bleeding in the diagnosis of endometrial cancer. The secondary outcomes are other parameters (specificity, VPP, VPN) of HE4, Evaluating the diagnostic capabilities of the CA125 marker alone and associated with HE4, as well as those of the REM and REM-B algorithms. We aim to include 100 patients over a period of one year in three centers. Discussion: As of now, there is no biological marker used in routine practice in the diagnosis of endometrial cancer. The ultimate goal of HE4 in endometrial cancer is to avoid surgery for those who are identified as non-sick. This study is the precursor of others for use in routine practice, HE4 would represent a great help to diagnosis if our study demonstrates it as reliable in the management of these patients and avoid many unnecessary and risky surgeries.

Background IgG2 responses are associated with repeated antigen exposure and display highly mutated variable domains. A recent study highlighted a role of IgG2+ memory B cells and allergen-specific IgG2 levels after a 3rd consecutive pre-seasonal sublingual allergen immunotherapy (AIT) with grass pollen tablet. Herein, we aim to explore changes in allergen-specific IgG2 in individuals undergoing house dust mite immunotherapy (HDM-AIT) and explore whether the interrelationship with other humoral responses (i.e., IgG4 and IgE) may discriminate between high and low responders. Methods Levels of serum Dermatophagoides pteronyssinus and Dermatophagoides farinae-specific IgG2, IgG4, and IgE antibodies were measured by ELISA or ImmunoCap in a sub-group of individuals enrolled in a randomized, double-blind, placebo-controlled, sublingual AIT study evaluating the safety and efficacy of a 300 IR HDM tablet. Results After 1-year sublingual AIT, HDM-specific serum IgG2 responses increase mostly in high versus low responders and are distinctive according to the clinical benefit. Higher correlation between HDM-specific IgG2, IgE, and/or IgG4 responses is seen in subjects benefiting the most from HDM-AIT as indicated by changes in Average Total Combined Scores. More strikingly, statistically significant correlation between HDM-specific IgG2 and IgE responses is only observed in individuals stratified as high responders. Conclusions We provide evidence for coordinated serum immune responses upon AIT in HDM-allergic subjects exhibiting high clinical benefit when compared with low responders. Assessing HDM-specific IgE, IgG2, and IgG4 in serum could be used as follow-up combined markers to support decision as to AIT continuation and/or adaptation.

In the early 1970s, studies of marine litter first appeared in the scientific literature. Fifty years later, knowledge of several coastal areas of the Atlantic, the driving forces of oyster farmers and aquaculture, is lacking. This work documents a pilot study on an Atlantic coastal area (France). This study aims to (i) characterize the abundance of macroplastics related to aquaculture tools; (ii) microplastics present in beach sediments and (iii) characterization of pollutants present on aquaculture plastics collected. First, it was observed that 70% of the plastics collected on the beach were characteristic of aquaculture materials. In sediments, MPs most found were Polyamide between 10 and 20 μm, with a total MP concentration of 397–457 MPs.kg−1. Pipes collectors (PVC), frequently used in aquaculture, have been shown to have concentrations of dimethylphthalates and naphthalene. Waste management and support policies can then base their actions on such studies, in order to improve their knowledge.

International audience; TIn families without a Cystic Fibrosis (CF) history, fetal ultrasound bowel abnormalities can unexpectedly reveal the disease. Isolated or in association, the signs can be fetal bowel hyperechogenicity, intestinal loop dilatation and non-visualization of fetal gallbladder. In these cases, search for CF transmembrane conductance regulator (CFTR) gene mutations is part of the recommended diagnostic practices, with a search for frequent mutations according to ethnicity, and, in case of the triad of signs, with an exhaustive study of the gene. However, the molecular diagnosis remains a challenge in populations without well-known frequent pathogenic variants. We present a multiethnic cohort of 108 pregnancies with fetal bowel abnormalities in which the parents benefited from an exhaustive study of the CFTR gene. We describe the new homozygous p.Cys1410* mutation in a fetus of African origin. We did not observe the most frequent p.Phe508del mutation in our cohort but evidenced variants undetected by our frequent mutations kit. Thanks to the progress of sequencing techniques and despite the difficulties of interpretation occasionally encountered, we discuss the need to carry out a comprehensive CFTR study in all patients in case of fetal bowel abnormalities.

International audience; BACKGROUND: The management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic. PATIENTS AND METHODS: We analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65years of age. RESULTS: We analyzed data from 332 outpatients’ case files between 9th of March and 30th of April 2020. The median age was 75years (range: 65-101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period. CONCLUSION: Our study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine.

BACKGROUND: Airplane de-icing technicians work from either an open-basket or closed-basket. OBJECTIVE: The objective of this study is to identify the tasks that have an influence on the physical fatigue of open-basket aircraft de-icing technicians. METHODS: In a Canadian airport during the winter of 2016–2017, a field study was conducted in which the heart rate of 12 volunteer participants was collected. The data was analyzed along with the 22 tasks that make up the activity of open-basket aircraft de-icing. For each participant, the mean absolute cardiac cost per task was compared. The evolution of the cardiac signal based on the resting heart rate and steady state limit was also characterized. RESULTS: According to the cumulative results fatigue occurs for periodic tasks as well as double tasks. More precisely, the most physically fatiguing tasks are spraying de-icing and anti-icing fluids, moving the basket and truck, as well as tactile control and de-icing quality control at ground level. CONCLUSIONS: Similar studies would need to be conducted in other aircraft de-icing facilities to improve the generalization of the results.

International audience

International audience; Nanoscale coal deformation affects thegeomechanics response of coal structure under external stress conditions. In this study, insitu small-angle neutron scattering (SANS) is used to characterize the evolution of nanopore structures under uni-axial compression on an Illinois coal specimen. Porod invariant mapping is used to estimate apparent porosities at different azimuthal angles. Structure-free orientation factors, including the alignment factor and Hermans’ orientation factor, are used to characterize orientation degree in nanopores quantitatively. The nanoscale pore deformation and evolution with stress have not been directly measured before, and the insitu SANS technique offers the unique capability to probe the nanoscale rock deformation. From the results, higher values of apparent porosities are shown near the coal bedding direction.At dif-ferent azimuthal angles, the apparent porosities increase with increasing uniaxial stress in the elastic deformation range (54–575bar) for the measured coal. The pore-scale degree of orientation is a size-dependent parameter, and pore orientation along the coal bedding generally increases as pore size increases. The degree of orientation in nanopores on average (in a size range between ~ 2 × 103Å and ~ 15Å) tends to increase first and then decreases with increasing stress loading, although different from that of macropores, indicating higher stresses on the nanopore edges along the bedding direction and then on the nanopore body along the normal direction. There is no distinct permanent change ofporosity within the measured stress range (0–575 bar)after the stress relief

International audience; Introduction In daily practice in haematology laboratories, red blood cell (RBC) abnormalities are frequent and their management is a real challenge. The aim of this study is to establish a "decision tree" using RBC and reticulocyte parameters from the SYSMEX XN-10 analyser to distinguish between patients with a hereditary RBC disease from iron deficiency anaemia and other patients. Methods We analysed results of complete RBC counts in a cohort composed of 8217 adults divided into 5 different groups: iron deficiency anaemia (n = 120), heterozygous haemoglobinopathy (n = 92), sickle cell disease syndrome (n = 56), hereditary spherocytosis (n = 18) and other patients (n = 7931). A Classification And Regression Tree (CART) analysis was used to obtain a two-step decision tree in order to predict these previous groups. Results Five parameters and the calculated RBC score were selected by the CART method: mean corpuscular haemoglobin concentration, percentage of microcytes, distribution width of the RBC histogram, percentage of nucleated red blood cells, immature reticulocytes fraction and finally RBC Score. When applying the tree and recommended flowchart, 158/166 of the RBC hereditary disease patients and 114/120 iron deficiency anaemia patients are detected. Overall, the correct classification rate reached 99.4%. Sensitivity and specificity for RBC disease detection were 95.2% and 99.9%, respectively. These results were confirmed in an independent validation cohort. Conclusion Based on the XN-10 RBC and reticulocyte parameters, we propose a two-step decision tree delivering a good prediction and classification of hereditary RBC diseases. These results can be used to optimize additional reticulocyte analysis and microscopy review.

Background We aimed to determine the prevalence of residual pulmonary vascular obstruction (RPVO) after symptomatic pulmonary embolism (PE) and to identify risk factors for RPVO. Methods On the basis of a prospective cohort of patients with a documented symptomatic venous thromboembolism, we included patients who had an acute PE and underwent a ventilation/perfusion lung scan at 3 to 24 months during the follow-up after PE. RPVO score was assessed for each patient. Initial pulmonary vascular obstruction at PE diagnosis was also assessed when available. Univariable and multivariable analyses were performed with preselected data to identify predictors for persistent defect defined as RPVO ≥ 5%. Results Among the 537 included patients, 278 (51.8%) had RPVO ≥ 5%, and 191 (35.6%) had RPVO ≥ 10%. In primary multivariate analysis on overall population, age ≥ 65 years (odds ratio [OR] 2.25, 95% CI, 1.45–3.52) and chronic respiratory failure (OR 3.19, 95% CI, 1.22–10.04) were independent predictors of RPVO ≥ 5%. In secondary multivariate analysis restricted to 256 patients with available initial pulmonary vascular obstruction score at index PE (IPVO), age ≥ 65 years (OR 2.78, 95% CI, 1.41–5.53), unprovoked PE (OR 2.11, 95% CI, 1.11–4.07) and IPVO ≥ 20% (OR 2.94, 95% CI, 1.68–5.20) were found to be independent risk factors for RVPO ≥5%. Conclusion In this selected population of patients with an acute PE, age ≥ 65 years, unprovoked PE and IPVO ≥ 20% at PE diagnosis appeared to be risk factors for residual pulmonary vascular obstruction measured at three to 24 months.

International audience; Electrochemical oxidation appears to be a practical technology for the decentralized treatment of wastewater in regions where sewer-based wastewater treatment is too expensive or otherwise impossible to construct and maintain. As of now, the control processes used by many systems rely principally on successive events that are time-dependent and come with some level of monitoring but little feedback into the system process. One reason is the high cost of sensors and automation systems used in industrial installations cannot easily translate into the household or public bathroom products for developing countries where capital expenditure is limited. As an answer to this challenge, we integrated a suite of inexpensive sensors (e.g., ORP, color, turbidity, voltage, current, water level, leakage) in and around the electrochemical treatment system and to a local computer (Raspberry Pi + Arduino) that can diagnose failure modes and send alerts to on-demand repair technicians and users. We also investigating the redesign of the sensors network to make it wireless at a low-cost in order to enjoy the benefits of wireless communications (e.g., monitoring flexibility, accessibility, and availability). The Wireless Sensor Network (WSN) will facilitate the installation of sensors as well as locating and managing failures.

Background: Anticoagulation is the mainstay of pulmonary embolism (PE) therapy, but it exposes patients to a risk of bleeding. Recent studies identified a high pulmonary vascular obstruction index (PVOI) as a risk factor for recurrent venous thromboembolism (VTE). Method: We used data from a French prospective cohort gathering consecutive PE events. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CT-spiral scan) at the time of PE diagnosis. All consecutive patients aged 18 or older were included except those with unavailable diagnosis exam or who received anticoagulation for other purpose than VTE. All patients had standardized follow-up, and independent clinicians adjudicated all events. Main outcome was recurrence of thromboembolic disease after stopping the anticoagulation. Results: 418 patients with PE were included, 293 (70,1%) being unprovoked, 89 (21.3%) provoked by major transient risk factor and 36 (8.6%) with active cancer. Mean follow-up after stopping anticoagulation was 3.60±2.69 years, during which 78 deaths and 109 recurrent VTE occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrent VTE (Hazard ratio 1.77, 95%CI 1.2-2.62, p Conclusion: PVOI ≥ 40% at PE diagnosis is associated with a higher risk of recurrence. This information may help clinician to guide the duration of anticoagulation.

Background Appropriate hand hygiene (HH) is key to reducing healthcare-acquired infections. The World Health Organization (WHO) recommends education and training to improve HH knowledge and compliance. Physicians are ranked among the worst of all healthcare workers for compliant handrubbing with its origin probably being the failure to learn this essential behavior during undergraduate medical studies. This study evaluated if the use of Ultraviolet-cabinets (UVc) for fluorescent-alcohol-based handrubs (AHR) during an undergraduate medical student training improved the compliance rate to the WHO hand hygiene recommendations (completeness of AHR application and HH opportunities). Methods This randomized trial compared a HH training with personal feedback (using UVc) to a control group. The first year, the students (2nd degree) were convened by groups (clusters) of 6–9 for a demonstration of the correct execution of WHO procedure. Randomization by cluster was done prior HH training. In the control group, the students hand rubbed under visual supervision of a tutor. In the intervention group after the same visual supervision, completeness of fluorescent-AHR hand application was recorded under UVc and was shown to the student. The intervention group had free access to the UVc until complete application. HH practices were included in simulation sessions for the both groups. One year after (3rd degree), all the students were asked to hand rub with fluorescent-AHR. A tutor (blinded to the study group) assessed the completeness of hand application under UVc and the compliance with the WHO opportunities. Complete application of AHR was defined as fluorescence for all the surfaces of hands and wrists. Results 242 students participated (140 in the intervention group and 102 in the control group). One year after the initial training, the rate of complete application of AHR was doubled in the intervention group (60.0% vs. 30.4%, p p Conclusion Using UVc for undergraduate medical students education to hand hygiene improves their technique and compliance with WHO recommendations.

Objective: Determining the factors associated with new-onset pre-diabetes and type 2 diabetes mellitus (T2D) is important for improving the current prevention strategies and for a better understanding of the disease. Design: To study the factors (clinical, circulating protein and genetic) associated with new onset pre-diabetes and T2D in an initially healthy (without diabetes) populational familial cohort with a long follow-up (STANISLAS cohort). Methods: A total of 1506 participants attended both the visit 1 and visit 4, separated by ≈20 years. Over 400 proteins, GWAS and genetic associations were studied using models adjusted for potential confounders. Both prospective (V1 to V4) and cross-sectional (V4) analyses were performed. Results: People who developed pre-diabetes (n = 555) and/or T2D (n = 73) were older, had higher BMI, blood pressure, glucose, LDL cholesterol, and lower eGFR. After multivariable selection, PAPP-A (pappalysin-1) was the only circulating protein associated with the onset of both pre-diabetes and T2D with associations persisting at visit 4 (i.e. ≈20 years later). FGF-21 (fibroblast growth factor 21) was a strong prognosticator for incident T2D in the longitudinal analysis, but not in the cross-sectional analysis. The heritability of the circulating PAPP-A was estimated at 44%. In GWAS analysis, the SNP rs634737 was associated with PAPP-A both at V1 and V4. External replication also showed lower levels of PAPP-A in patients with T2D. Conclusions: The risk of developing pre-diabetes and T2D increases with age and with features of the metabolic syndrome. Circulating PAPP-A, which has an important genetic component, was associated with both the development and presence of pre-diabetes and T2D.

Background: The cancer population seems to be more susceptible to COVID-19 infection and have worse outcomes Front of this pandemic, we had to adapt our patient care to protect our patients without compromising their prognosis related to their cancer The national PRATICOVID study aims to describe the modification of the medical and surgical patient care for this population, according to the recommendations in this context of pandemic, within our hospitals which are strongly mobilized Methods: We analyzed data from 9 different institutions, 3 Military Hospitals, 4 Academics Hospital, 2 Private Hospital, from oncologists, surgeons, radiotherapists The primary endpoint was to assess the prevalence of adapted patient care during pandemic The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic Results: We analyzed 435 medical care between 9th of March and 30th of April The median age was 69 years (range, 24-99), 54% was male 167 patients (38 4%) were newly diagnosed and only 4% were included in a clinical trial Because of COVID-19 pandemic, 47 6% of the outpatients had modified patient care The main primary tumor site was breast cancer (22 7%) at a metastatic stage 24 6% have postponed surgery, or not receive perioperative chemotherapy, 18 4% received hypofractioned schedule and 57% had an adaptive systemic protocol (stopped, oral protocol, spacing between cures) 70% of physicians are used telemedicine During this period, 67% of the physicians were relaxed to taking care of their patients 57% of the patients have seen to be relaxed or low worried about the pandemic However, 71% are worried after the lockdown, because of future patient care, stage at diagnosis, access to clinical trial, our abilities to receive in the same time all the patients Conclusions: PRATICOVID study is the first to assess modification of patients cares during an epidemic in cancer outpatients Faces with this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus and while ensuring the course of patient care But physicians are worried after de lockdown because of the care pathway’s issues Clinical trial identification: CNIL;reference number: 2217722v0 Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

Objectives:68Ga Ventilation/Perfusion V/Q PET-CT is a promising imaging tool for pulmonary embolism diagnosis. However, no study has verified whether the interpretation is reproducible between different observers. The aim of this study was to assess the interobserver agreement in the interpretation of V/Q PET-CT for the diagnosis of acute PE, and to compare it to the interobserver agreement of CTPA interpretation.Methods: Twenty-four cancer patients with suspected acute PE underwent V/Q PET-CT and CTPA within 24 h as part of a prospective pilot study evaluating V/Q PET-CT for the management of patients with suspected PE. V/Q PET-CT and CTPA scans were reassessed independently by four nuclear medicine physicians and four radiologists, respectively. Physicians had different levels of expertise in reading V/Q scintigraphy and CTPA. Interpretation was blinded to the initial interpretation and any clinical information or imaging test result. For each modality, results were reported on a binary fashion. V/Q PET/CT scans were read as positive if there was at least one segmental or two subsegmental mismatched perfusion defects. CTPA scans were interpreted as positive if there was a constant intraluminal filling defect. Interobserver agreement was assessed by calculating kappa (κ) coefficients.Results: Out of the 24 V/Q PET-CT scans, the diagnostic conclusion was concordantly negative in 22 patients and concordantly positive in one patient. The remaining scan was interpreted as positive by one reader and negative by three readers. Out of the 24 CTPA scans, the diagnostic conclusion was concordantly negative in 16 and concordantly positive in one. Out of the seven remaining scans, PE was reported by one reader in four cases, by two readers in two cases, by three readers in one case. Most of discordant results on CTPA were related to clots reported on subsegmental arteries. Mean kappa coefficient was 0.79 for V/Q PET-CT interpretation and 0.39 for CTPA interpretation.Conclusions: Interobserver agreement in the interpretation of V/Q PET-CT for PE diagnosis was substantial (kappa 0.79) in a population with a low prevalence of significant PE. Agreement was lower with CTPA, mainly as a result of discrepancies at the level of the subsegmental arteries.

Price, origin, and type of production are all known to influence consumer choices when it comes to fresh food. However, the interactions between these factors have received limited attention in the food choice literature. With the growth of online grocery shopping services, another under-investigated issue is the willingness to buy (WTB) fresh food products sold online. Our aim was to partially fill these gaps, by applying a scenario-based methodology. We exposed 324 individuals to 54 scenarios describing a situation in which a character goes to buy apples. The scenarios featured all possible combinations of four within-participants factors: purchase site (traditional market or online grocery shopping service), origin (within 50 km of the character’s home, elsewhere in France, or foreign country), price (low, average, or high), and type of production (organic, sustainable or conventional farming). For each scenario, participants rated their WTB for the apples on sale. Analyses conducted on the whole sample showed that consumers’ WTB was higher for locally grown, organic, and low-priced apples. Furthermore, cluster analysis revealed three consumer segments with different behavioral profiles. Price-sensitive consumers’ WTB was higher for imported apples at a low price than for local apples at a high price. Non-online consumers unconditionally rejected the online grocery shopping service regardless of the apples’ price, origin, and type of production. Organic consumers were more willing to buy imported organic apples than domestic conventional ones. Hence, consumers’ preferences for domestic products should be interpreted in the light of factors such as price and type of production.

L’évaluation ponctuelle du risque suicidaire habituellement conduite aux urgences, après un geste suicidaire, ne rend pas compte de son évolution après la sortie des soins, alors même que le risque de récidive reste important plusieurs mois après. Dans ces conditions, les possibilités d’identification, et donc de prise en charge, des patients à risque suicidaire sont limitées. Le développement de la santé connectée (eHealth) donne désormais accès en temps réel à des informations sur l’état de santé d’un patient entre deux séjours en centre de soins. Cette extension de l’évaluation clinique à l’environnement du patient permet de développer des outils d’aide à la décision face à la gestion du risque suicidaire.

This paper examines modeling and control of a large population of grid-connected plug-in electric vehicles (PEVs). PEV populations can be leveraged to provide valuable grid services when managed via model-based control. However, such grid services cannot sacrifice a PEV’s primary purpose—mobility. We consider an aggregator, which can control a fleet of PEVs with three possible charging rates: charging at a constant rate, discharging at a constant rate or idle. We develop a system of coupled partial differential equations for aggregating large populations of PEVs and transform its discretized version into a state space representation. We propose a linear quadratic regulator to track a power signal that provides load following services. We investigate the sensitivity of controller parameters, different bidding strategies and their impact on the performance of the provided balancing service. We examine this control design on a simulated case study and analyze sensitivity to a variety of assumptions and parameter selections.

In the field of healthcare, IT has been constantly evolving for decades. It has revolutionised and professionalised the practices of healthcare workers. It has helped to improve traceability, reliability, information exchange and continuity of care. New information and communication technologies have also contributed to the development of research.

Resume Introduction Nocardia est un germe opportuniste chez les patients presentant une immunodepression cellulaire ou une pathologie pulmonaire chronique. Les portes d’entree les plus frequentes sont l’appareil respiratoire par inhalation ou l’inoculation directe par une effraction cutanee. Les nocardioses peuvent etre localisees ou disseminees. Observation Nous rapportons une observation rare de nocardiose disseminee a Nocardia nova avec atteinte pulmonaire, cutanee, cerebrale et osteomyelite femorale. Le diagnostic etait fait grâce aux cultures prolongees du liquide broncho-alveolaire et du pus issu d’une lesion cutanee. L’evolution etait favorable sous antibiotherapie adaptee prolongee par imipenem et amikacine puis cotrimoxazole. Conclusion Cette observation est originale car elle atteint un sujet immunocompetent avec une association de deux atteintes exceptionnelles pour N. nova : l’atteinte cerebrale et osseuse. La recherche de formes cerebrales doit etre systematique, meme en l’absence de signes neurologiques patents. Une antibiotherapie adaptee et prolongee doit etre la regle.

A 6-year-old boy with acute myeloid leukaemia (AML) was admitted for his third cycle of chemotherapy on Children’s Oncology Group Protocol AALL1831 (cytarabine 1000 mg/m2 every 12 hours and etoposide 150 mg/m2 daily for days 1–5). On day 3 he developed pain, erythema and oedema of his hands. He

Background: Lipohypertrophy (LH) is highly prevalent and is potentially harmful to insulin-injecting patients. Methods: In this study, we assessed the impact of injection technique (IT) education, including use of a 4-mm pen needle on insulin-treated patients with clinically observed LH in a randomized, controlled, prospective multicenter study in France with follow-up of 6 months. Intensive education and between-visit reinforcement were given to the intervention group. Control patients received similar messages at study outset. Results: A total of 123 patients were recruited (age 52.1 ± 15.7 years; men 70.7%; body mass index >30 kg/m2: 34.2%; type 1: 53.7%; years with diabetes mellitus: 18.1 ± 10.5), of which 109 patients were included in the final analysis. The intervention group (n = 53) showed a significant decrease of total daily dose of insulin (average at baseline: 54.1 IU) at 3 months (T-3) and 6 months (T-6), reaching just over 5 IU versus baseline (P = 0.035). Corresponding, although not significant, decreases occurred in controls (n = 56); between-group differences were not significant. There were significant decreases in HbA1c (up to 0.5%) at T-3 and T-6 in both groups, with no significant differences between groups. A significant number of intervention patients improved their IT habits; about half achieved ideal IT habits by T-3 versus a quarter of control patients. By T-6, 2/3 of intervention patients achieved either ideal or acceptable IT habits, while only 1/3 of control patients did. Conclusions: Our intervention was effective in both study arms, however, to a greater degree and more rapidly in the intervention group. Widespread application of this intervention could be highly cost-effective.

Objectifs Depuis decembre 2019, nous devons faire face a la pandemie mondiale du COVID-19. Cela a entraine une adaptation des soins, notamment pour les patients atteints d’un cancer urologique. L’etude PRATICOVID vise a decrire la modification de la prise en charge medicale et chirurgicale des patients pour cette population, selon les recommandations dans ce contexte de pandemie, au sein de nos hopitaux fortement mobilises. Methodes Nous avons analyse les donnees de 9 institutions differentes : 3 hopitaux militaires, 4 hopitaux universitaires, 2 hopitaux prives. Nous avons considere les patients suivis par les oncologues, chirurgiens et radiotherapeutes. Au total, 435 patients ont ete inclus entre le 9 mars et le 30 avril 2020 dans l’etude PRATICOVID. Parmi eux 178 patients presentaient un cancer urologique. Le critere d’evaluation principal etait d’evaluer la prevalence des soins adaptes aux patients pendant la pandemie. Les criteres d’evaluation secondaires etaient de decrire le point de vue des cliniciens et des patients pendant et apres la pandemie. Resultats Cent quarante-cinq patients avec un cancer urologique ont ete retenus pour l’analyse finale. L’âge median etait de 71 ans (24–97), dont 90,3 % etaient des hommes. Parmi les patients, 62 (42,8 %) etaient nouvellement diagnostiques et seuls 10 etaient inclus dans un essai clinique. En raison de la pandemie de COVID19, 46,2 % des patients ambulatoires avaient modifie les soins aux patients. Le cancer de la prostate representait 50,7 % des cancers urologiques avec une modification de prise en charge. La chirurgie ne concernait que 11 % des patients inclus contre 56,6 % pour les traitements systemiques. Parmi les patients, 31,7 % ont beneficies exclusivement d’une teleconsultation. Parmi les medecins, 67 % etaient detendus et 57 % des patients se sont dits detendus ou peu inquiets par rapport a la pandemie. Parmi les patients, 71 % sont inquiets pour l’evolution de leur maladie. Conclusion L’etude PRATICOVID est la premiere a evaluer la modification des soins lors d’une epidemie des patients cancereux. Le suivi a long terme de ces patients est necessaire pour mesurer l’impact en termes de survie globale, specifique et sans progression.

The cancer population seems to be more susceptible to COVID‐19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID‐19 pandemic, 47.6% of the outpatients received modified patient care. Twenty‐four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues., The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care.

Background Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. Methods We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24 h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. Results Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%–38%] and median ABSI was 7 [5–9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2–24] vs. 6 days [2–17] (P = 0.3) and 17 days [4–32] vs. 8 days [3–23] (P = 0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2–24] in the Intervention phase (P = 0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P = 0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P = 0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P = 0.6). Conclusion Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.