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Background: Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients. Methods: We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI. Results: Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73–0.88] and a high NPV of 95.9 [88.6–98.5] %. Conclusions: Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy. [ABSTRACT FROM AUTHOR]

The article focuses on the need for analyzing the content and discusses the limits of an arbitral tribunal power to act as amiable compositor, an unbiased third party under international law. It discusses the consequences of an unauthorized ex aequo et bono, a judgment based on fair judgment. Topics discussed include preliminaries of deciding amiable compositor or ex aequo et bono and consequences of an unauthorized ex aequo et bono decision in respect of Germany, France and Northern Ireland.

Background: Most patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire for information. The purpose of this study was to translate the APAIS into French and to evaluate the psychometric properties of the French version of the APAIS. Methods: The process consisted of two steps. The first step involved the production of a French version of the APAIS that was semantically equivalent to the original version. In the second step, we evaluated the psychometric properties of the French version, including the internal consistency and reliability, the differential item functioning, and the external validity. Participants older than 18, undergoing elective surgery (except obstetric), able to understand and read French, and able to complete a self-report questionnaire were eligible for inclusion in the study. A forward-backward translation was performed. The psychometric evaluation covered three domains: internal validity, external validity, and acceptability. Within 4-48 h after surgery, the patients were asked to complete the “Evaluation du Vécu de l'ANesthésie” questionnaire” (EVAN) questionnaire, which is a validated, multi-dimensional questionnaire that assesses the patient's experiences in the perioperative period. Results: A database with 175 patients was created. The principal component factor analysis revealed the same three-dimensional structure as the original scale. The confirmatory factor analysis showed a strong fit with a root mean square error of approximation of 0.069 and a comparative fit index of 1.00. The amount of differential item functioning (DIF) between the subgroups of patients (i.e., based on age, gender, type of anaesthesia or surgery, premedication, ASA physical status, and ambulatory course) was low. The APAIS was strongly correlated with the dimensions of the EVAN. Each dimension had a low proportion of missing values (ranging from 0.6 to 2.9%), which indicates good acceptability of the questionnaire. Conclusions: The French version of the APAIS is valid and reliable. The availability of this tool enables the evaluation of anxiety in French patients undergoing anaesthesia. [ABSTRACT FROM AUTHOR]

Abstract: In this study, we report the development of a rapid real-time polymerase chain reaction (PCR) assay with TaqMan® probe to detect the New Delhi metallo-β-lactamase (NDM-1)-encoding gene directly from bacterial isolates. The specificity of the assay was verified in silico as well as with a large panel of 84 clinically relevant bacteria, including the Klebsiella pneumoniae NCTC 13443 NDM-1-positive reference strain. Using this assay retrospectively on a local series of 44 K. pneumoniae isolates from Marseille Hospitals (France), it was possible to detect and identify an NDM-1-producing K. pneumoniae strain isolated from bronchoalveolar lavage in April 2010 from a French patient repatriated from India after a motorbike accident. Standard PCR amplification and sequencing of the entire NDM-1 gene from this isolate was also performed and the amino acid sequence showed 100% homology with the NDM-1 protein from the K. pneumoniae reference strain. We believe that this real-time PCR assay would be a powerful tool that could be added to other molecular detection assays such as detection of KPC- or OXA-encoding genes for rapid screening and/or identification of carbapenem-resistant bacterial isolates from patients returning from the Asian continent that could be implemented in a point-of-care strategy. [Copyright &y& Elsevier]

Protein fingerprinting using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI--TOF MS) is a rapid, reliable, and economical method to characterize isolates of terrestrial fungi and other microorganisms. The objective of our study was to evaluate the suitability of MALDI-TOF MS for the identification of aquatic hyphomycetes, a polyphyletic group of fungi that play crucial roles in stream ecosystems. To this end, we used 34 isolates of 21 aquatic hyphomycete species whose identity was confirmed by spore morphology and internal transcribed spacer (ITS1-5.8S-ITS2 = ITS) nuc rDNA sequencing. We tested the efficiency of three protein extraction methods, including chemical and mechanical treatments using 13 different protocols, with the objective of producing high-quality MALDI-TOF mass spectra. In addition to extraction protocols, mycelium age was identified as a key parameter affecting protein extraction efficiency. The dendrogram based on mass-spectrum similarity indicated good and relevant taxonomic discrimination; the tree structure was comparable to that of the phylogram based on ITS sequences. Consequently, MALDI-TOF MS could reliably identify the isolates studied and provided greater taxonomic accuracy than classical morphological methods. MALDI-TOF MS seems suited for rapid characterization and identification of aquatic hyphomycete species.