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Objectives A strong COVID-19 vaccine campaign is needed to reach the herd immunity and reduce this pandemic infection. Study design In the Foch Hospital, France, in February 2021, 451 healthcare workers were vaccinated by a first dose of AstraZeneca vaccine. Methods Adverse effects were reported to our pharmaco-vigilance circuit, by an online and anonymous questionnaire following the first weeks of the vaccinal campaign to healthcare workers. Results Two hundred seventy-four (60.8%) of them reported multiple adverse effects. Main adverse effects reported were feverish state/chills (65.7%), fatigue/physical discomfort (62.4%), arthralgia/muscle pain (61.0%) and fever (44.5%). Conclusions On March 2021 many European countries suspended AstraZeneca vaccine for one week due to safety uncertainty. Thus, confidence in its efficacy is undermined. However, the benefit/risk balance is clearly in favor of vaccination.

Resume La transplantation pulmonaire (TP) est le seul traitement qui puisse etre propose pour permettre la survie des patients en insuffisance respiratoire terminale. L’objectif de notre etude est d’explorer les progres realises au cours des deux dernieres decennies pour demontrer l’efficacite et la securite de ce traitement. Methodes Analyse retrospective d’une cohorte monocentrique des 600 premiers patients ayant eu consecutivement une TP a l’hopital Foch (Suresnes, France) entre 1988 et 2014. Cette cohorte a ete divisee en 3 groupes chronologiques de 200 patients (1988–2004, 2004–2011, 2011–2014) Resultats La duree d’attente, la mortalite perioperatoire, l’incidence des rejets aigus cellulaires de la premiere annee et du rejet chronique (RC) a 5 ans ont toutes diminue. La survie actuarielle globale a 1 et 5 ans, de 78 % et 57 % pour les 600 patients, est passee a 86 % et 75 % pour les 200 derniers (> 2011). Elle est meilleure a 5 ans pour la mucoviscidose (68 %) que pour l’emphyseme (54 %) et la fibrose pulmonaire (37 %). Pour les 200 derniers patients, elle est a 5 ans de 81 % pour la mucoviscidose, de 78 % pour l’emphyseme et de 47 % pour les fibroses. Elle est de 60 % a 5 ans en cas de transplantation dite de super-urgence. Une surveillance attentive et prolongee doit detecter les complications proliferatives et gerer l’hypertension et la toxicite renale medicamenteuse. Conclusion En 25 ans, des progres considerables en TP ont hisse cette procedure au rang de therapeutique reconnue de l’insuffisance respiratoire chronique terminale.

Background: Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI. Methods: Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions. Results: Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P =0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P =1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42–3.09], P P =0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions. Conclusions: Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.

Objectives This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival. Background An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases. Methods From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk ( 200 points) for in-hospital death. Results A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p Conclusions In cardiac arrest patients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.

Objectives The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed ( Discussion Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

Soil microbes yield insecticidal peptide The microbial peptide BT, derived from the bacterium Bacillus thuringiensis , is widely used to protect crops from insect pests. Schellenberger et al. identified another insecticidal peptide from a different soil-dwelling bacterium, Pseudomonas chlororaphis (see the Perspective by Tabashnik). Corn plants expressing the Pseudomonas peptide were protected from attack by western corn rootworm. Rootworms that were resistant to BT were susceptible to the Pseudomonas peptide. Addition of another insecticidal peptide diversifies the arsenal against insect pests, which may slow down the development of resistance. Science , this issue p. 634 ; see also p. 552

Background Homeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by chronic lung allograft dysfunction, an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling. Objective This study assessed whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling posttransplantation. Methods Microbiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post lung transplantation. Expression of a set of 11 genes encoding either matrix components or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively) was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture. Results We identified 4 host gene expression profiles, among which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by proinflammatory bacteria (eg, Staphylococcus, Pseudomonas, and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (eg, Prevotella, Streptococcus, and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact host macrophage-fibroblast activation and matrix deposition. Conclusions Host-microbes interplay potentially determines remodeling activities in the transplanted lung, highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome., Graphical abstract

Lung transplantation is deemed to be the only effective therapy that improves survival for patients with end stage lung disease. The aim of our study was to examine the progress achieved over the last two decades and to demonstrate the effectiveness and safety of this treatment.A retrospective analysis of a cohort of 600 consecutive lung transplant patients treated at the hospital Foch (Suresnes, France) between 1988 and 2014. They were split into three groups of 200 patients each: 1988-2004, 2004-2011, 2011-2014.Time and mortality on waiting list, perioperative mortality, the incidence of acute rejection in the first year and chronic lung allograft dysfunction (CLAD) at 5 years posttransplantation, have all decreased. Global survival at 1 and 5 years for the 600 patients increased from 78% and 57% to 86% and 75% respectively for the 200 last patients. Patients with cystic fibrosis have a better 5 year survival than those with emphysema or pulmonary fibrosis (68% vs. 54 % for emphysema and 37% for fibrosis). For the last 200 patients, 5 year survival is 81% for CF patients, 78 % for emphysema and 47% for fibrosis. Emergency transplantation had a 60% 5 years survival. Proliferative complications, arterial hypertension and renal function impairment are being monitored long term.The twenty-five years experience shows a consistent improvement in the results of lung transplantation which is now accepted as the only effective curative treatment for end stage lung disease.

OBJECTIVES Only 15% of brain death donors are considered suitable for lung transplantation (LTx). The normothermic ex vivo lung perfusion technique is used to potentially increase the availability of high-risk lung donors. We report our experience of LTx with initially rejected donors after ex vivo lung reconditioning (EVLR). METHODS From April 2011 to May 2013, we performed EVLR for 32 pairs of donor lungs deemed unsuitable for transplantation and rejected by the 11 French lung transplant teams. After EVLR, lungs with acceptable function were transplanted. During the same period, 81 double-lung transplantations (DLTx) were used as controls. RESULTS During EVLR, 31 of 32 donor lungs recovered physiological function with a median PO2/FiO2 ratio increasing from 274 (range 162-404) mmHg to 511 (378-668) mmHg at the end of EVLR (P < 0.0001). Thirty-one DLTx were performed. The incidence of primary graft dysfunction 72 h after LTx was 9.5% in the EVLR group and 8.5% in the control group (P = 1). The median time of extubation, intensive care unit and hospital lengths of stay were 1, 9 and 37 days in the EVLR group and 1 (P = 0.17), 6 (P = 0.06) and 28 days (P = 0.09) in the control group, respectively. Thirty-day mortality rates were 3.3% (n = 1) in the EVLR group and 3.7% (n = 3) in the control group (P = 0.69). One-year survival rates were 93% in the EVLR group and 91% in the control group. CONCLUSIONS EVLR is a reliable and repeatable technique that offers a significant increase of available donors. The results of LTx with EVLR lungs are similar to those obtained with conventional donors.

This case illustrates how accounting rules impact the public interest and vice versa. The setting is a gray area of accounting in which management, the external auditors, the SEC, and international accounting standard setters may have differing opinions about the accounting treatment. Students consider the situation in which an accounting rule leads to a business and societal problem. They gain an understanding of how this happens and how such problems can be addressed. The context for this case is a revenue recognition issue for bill-and-hold sales. It also provides students with the opportunity to consider the real-world implications of accrual- versus cash-based accounting. This case is useful for intermediate- to graduate-level financial accounting classes or an accounting capstone class.

La transplantation pulmonaire, actuel traitement de reference des insuffisances respiratoires terminales, connait un essor important depuis quelques annees. Les suites postoperatoires peuvent etre tres simples, le patient etant extube d’emblee, le sejour en reanimation est alors tres court. Des complications peuvent toutefois survenir precocement chez ces patients lourdement immunodeprimes, et necessiter une prise en charge specifique en reanimation. Il peut s’agir d’une defaillance primaire du greffon, liee aux phenomenes d’ischemie-reperfusion, de complications infectieuses essentiellement bacteriennes pulmonaires ou d’un rejet cellulaire. La mortalite precoce est encore de 10 a 20 %. Une prise en charge multidisciplinaire est indispensable pour gerer au mieux cette phase postoperatoire. Plus a distance, les readmissions en reanimation sont surtout liees a des defaillances respiratoires d’origine infectieuse. Le pronostic depend alors de l’etat respiratoire sous-jacent et de la severite initiale.

Background The increasing use of immunosuppressive and cytotoxic therapies leads to a growing number of opportunistic infections especially Pneumocystis jirovecii pneumonia (PCP). The purpose of our study was to describe the population involved, and to assess clinical, biological, and mortality data. Methods We collected retrospectively the whole medical file of all PCP cases diagnosed in non-HIV infected patients, in two French University Hospitals in the last decade (1999-2009). Diagnosis was made on standard coloration and/or immunofluorescence analysis of bronchoalveolar lavage fluid (BAL). Results Forty-one patients were included in the study, mean age 56 (±12.5) years, sex ratio 0.71 men/woman. Underlying diseases were as follow: 12 patients (29%) were renal transplant recipients, 13 (32%) were treated for solid cancers, and 16 (39%) suffered from various diseases (three allogenic bone-marrow transplantation, 11 hematological malignancies, one pulmonary transplantation, one vasculitis). Twelve patients died (i.e. 29%). Median lymphocyte count was 542/mm(3). More than 85% patients received corticosteroids at a median cumulative 6-month dose of 2700mg. Seven patients (17%) had a PCP prophylaxis. Clinical worsening at day 5 (P Discussion/conclusion The prognosis factors found are mostly linked to the patients' clinical severity. We would like to highlight: first, near to 30% mortality rate, secondly, a lack of prophylaxis in 34 patients, reflecting the difficulty to define PCP's risk in non HIV-infected patients.

Resume Objectif Comparer les caracteristiques de la grippe A H1N1 2009 chez les patients transplantes a celles des patients non transplantes, et evaluer l’evolution des transplantes pendant le semestre suivant l’infection. Methodes Patients ayant eu une grippe A confirmee, dans trois centres parisiens de transplantation, entre le 1 er septembre 2009 et le 15 fevrier 2010. Les symptomes, les resultats biologiques et radiologiques, et le traitement ont ete analyses et compares retrospectivement entre patients transplantes et non transplantes. L’evolution a ete evaluee par questionnaire, realisation d’un scanner thoracique un a trois mois apres la grippe et etude de la variation du VEMS. Resultats Nous avons inclus 57 patients non transplantes et 13 patients allo-greffes (poumons : huit, rein : quatre, cellules souches hematopoietiques : un). Parmi les patients transplantes et non transplantes respectivement : (1) hospitalisation : 100 % (13 sur 13) versus 54 % (31 sur 57) ( p = 0,0013) ; (2) pneumonies : 62 % (huit sur 13) versus 26 % (huit sur 57) ( p = 0,004) ; (3) taux de mortalite des patients hospitalises : 7,7 % (un sur 13) versus 9,7 % (trois sur 57) ( p = NS) ; (4) persistance d’anomalies scanographiques chez quatre patients transplantes ; (5) diminution de plus de 10 % du VEMS chez quatre patients greffes pulmonaires sur sept. Conclusion Nos resultats suggerent que la grippe A H1N1 2009 chez les patients transplantes est, comparee aux patients non transplantes, (1) plus souvent a l’origine d’hospitalisation ; (2) plus frequemment compliquee de pneumonie ; (3) responsable d’une alteration fonctionnelle respiratoire persistante chez les patients transplantes pulmonaires ; (4) responsable d’une mortalite similaire a celle des patients hospitalises pour grippe A H1N1 2009, non transplantes.

Purpose – The purpose of this paper is to investigate the impact of different levels of environmental information on key consumer metrics. More specifically, it aims to evaluate environmentally benign products against those that have negative environmental impacts.Design/methodology/approach – Multiple product categories and messages that varied from strongly negative to strongly positive were used to test whether the accuracy/completeness of the information changes consumers' view of green products.Findings – The results show that consumer perception of product quality, value, and purchase intentions does not differ significantly between products with positive environmental messages and those without any message. Products with positive environmental messages are viewed better than products with negative environmental messages. It is also found that the impact of environmental information is greater for consumable products.Practical implications – Clearly presented information can make a significant diffe...

Resume Les contusions pulmonaires sont des lesions traumatiques pulmonaires rencontrees dans environ 50 % des traumatismes thoraciques graves. Il s'agit dans la majorite des cas de polytraumatismes. En dehors d'une destruction pulmonaire etendue, la lesion traumatique primitive (zone contuse), caracterisee par des ruptures alveolocapillaires hemorragiques et des lacerations parenchymateuses, est souvent peu symptomatique. L'evolution est marquee par une reaction inflammatoire, d'origine pulmonaire et systemique ; son importance conditionne la survenue d'un œdeme pulmonaire lesionnel diffus dont depend le pronostic. Maximale au troisieme jour, l'insuffisance respiratoire s'ameliore vers la fin de la premiere semaine en l'absence de complication. Le diagnostic repose sur le scanner thoracique qui peut permettre d'aider a apprecier le risque de recours a la ventilation mecanique. Il n'existe pas de traitement medicamenteux specifique. La prise en charge de la detresse respiratoire est symptomatique ; en cas d'atteinte parietale une analgesie optimale doit etre assuree pour permettre une kinesitherapie efficace.

Summary Many candidates for lung transplantation (LT) die on the waiting list, raising the question of graft availability and strategy for organ allocation. We report the experience of the new organ allocation program, “High Emergency Lung Transplantation” (HELT), since its implementation in our center in 2007. Retrospective analysis of 201 lung transplant patients, of whom 37 received HELT from 1st July 2007 to 31th May 2012. HELT candidates had a higher impairment grade on respiratory status and higher Lung Allocation Score (LAS). HELT patients had increased incidence of perioperative complications (e.g., perioperative bleeding) and extracorporeal circulatory assistance (75% vs. 36.6%, P = 0.0005). No significant difference was observed between HELT and non-HELT patients in mechanical ventilation duration (15.5 days vs. 11 days, P = 0.27), intensive care unit length of stay (15 days vs. 10 days, P = 0.22) or survival rate at 12 (81% vs. 80%), and 24 months post-LT (72.9% vs. 75.0%). Lastly, mortality on the waiting list was spectacularly reduced from 19% to 2% when compared to the non-HELT 2004–2007 group. Despite a more severe clinical status of patients on the waiting list, HELT provided similar results to conventional LT. These results were associated with a dramatic reduction in the mortality rate of patients on the waiting list.

Introduction et but de l’etude L’insuffisance intestinale (IF) designe la reduction de la fonction intestinale en deca du minimum necessaire a l’absorption des macronutriments et/ou de l’eau et des electrolytes, necessitant une supplementation intraveineuse. La chirurgie bariatrique par les modifications anatomiques induites ou par ses complications semble devenir une cause d’IF. L’objectif de l’etude etait de decrire les caracteristiques des patients atteints d’IF apres chirurgie bariatrique, d’en determiner les principaux mecanismes et d’etudier le devenir de ces patients. Materiel et methodes Il s’agit d’une etude retrospective monocentrique realisee entre 2002 et 2014 a partir d’une cohorte de 360 patients avec IF dependants de nutrition parenterale NP ou perfusions hydroelectrolytiques HE. Tous les patients dont la cause de l’IF etait la chirurgie bariatrique ont ete inclus. Les resultats ont ete exprimes en moyenne (V min -V max ). Resultats et analyse statistique Vingt patients de 42 ans (25–64) lors de la chirurgie bariatrique avec un indice de masse corporelle (IMC) de 48,7 kg/m 2 (36–74) ont ete pris en charge apres 55 mois (2–444 mois) pour IF. Le poids lors de la prise en charge etait de 65 kg (34–106 kg) soit une perte de poids moyenne de 68 kg (36–129 kg). Les procedures chirurgicales etaient de type bypass en omega ( n = 8/20), bypass gastrique en Y ( n = 7/20), anneau gastrique ( n = 4/20) et sleeve ( n = 1/20). Les complications postoperatoires chez 11 patients sur 20 etaient : ischemie mesenterique ( n = 5), peritonite ( n = 3) et fistule anastomotique ( n = 3). Les procedures chirurgicales associees aux complications etaient une gastrectomie ( n = 11/20), une resection intestinale ( n = 10), une reversion du bypass ( n = 1/20). Les mecanismes attribues a la denutrition etaient une malabsorption excessive ( n = 16), une baisse des ingesta ( n = 7) ou un hypercatabolisme ( n = 5). Le bilan digestif comprenait : une evaluation du montage digestif (anse commune), un bilan de coprologie fonctionnelle (calorimetrie fecale et elastase) realisee a partir des selles de 3 jours (six patients), un breath test au glucose (six patients), un aminoacidogramme(13 patients). Parmi les patients avec malabsorption excessive, les mecanismes favorisants l’ II etaient : un syndrome de grele court ( n = 9), une anse commune courte ( n = 5), une pullulation bacterienne chronique du grele ( n = 5), une insuffisance pancreatique exocrine ( n = 5). La citrulline etait a 29 μmol/L (14–57). Dans 5 cas, la citrullinemie etait Conclusion L’IF apres chirurgie bariatrique est une cause nouvelle de NPAD. Multifactorielle, elle necessite une prise en charge nutritionnelle et gastroenterologique globale. Ainsi, dans la majorite des cas un sevrage de NP est obtenu. Une meilleure connaissance des capacites fonctionnelles de l’intestin opere permettrait de prevenir les complications potentiellement graves de cette chirurgie.

In recent years, many business schools have developed integrative programs in response to a number of internal and external factors. Although the exact nature of these programs varies, a significant common element is a desire to impart to students appreciation, knowledge, and skills for cross-functional business situations. This article focuses on marketing’s key role. With its rich history on drawing from and contributing to other academic disciplines, marketing is in a powerful position to serve an important role in guiding and binding together other areas in an integrated program. The article provides guidance and background to marketing academicians, which allows them to add integrated components to existing classes and/or programs or begin the design of an integrated program.

This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H2O (p = 0.005) and minute ventilation from 13 +/- 3.5 to 11 +/- 3 L/min. CO2 removal by IVOX allowed a significant decrease in PaCO2 from 66 +/- 15 to 59 +/- 13 mm Hg. Improvement of oxygenation with IVOX was not significant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study.

The increasing use of immunosuppressive and cytotoxic therapies leads to a growing number of opportunistic infections especially Pneumocystis jirovecii pneumonia (PCP). The purpose of our study was to describe the population involved, and to assess clinical, biological, and mortality data.We collected retrospectively the whole medical file of all PCP cases diagnosed in non-HIV infected patients, in two French University Hospitals in the last decade (1999-2009). Diagnosis was made on standard coloration and/or immunofluorescence analysis of bronchoalveolar lavage fluid (BAL).Forty-one patients were included in the study, mean age 56 (±12.5) years, sex ratio 0.71 men/woman. Underlying diseases were as follow: 12 patients (29%) were renal transplant recipients, 13 (32%) were treated for solid cancers, and 16 (39%) suffered from various diseases (three allogenic bone-marrow transplantation, 11 hematological malignancies, one pulmonary transplantation, one vasculitis). Twelve patients died (i.e. 29%). Median lymphocyte count was 542/mm(3). More than 85% patients received corticosteroids at a median cumulative 6-month dose of 2700mg. Seven patients (17%) had a PCP prophylaxis. Clinical worsening at day 5 (P0.003), poor control of the underlying disease (P0.015), WHO performans status superior than 2 (P0.025), high temperature (P0.04), and high oxygen flow (P0.042) were linked to a poor prognosis.The prognosis factors found are mostly linked to the patients' clinical severity. We would like to highlight: first, near to 30% mortality rate, secondly, a lack of prophylaxis in 34 patients, reflecting the difficulty to define PCP's risk in non HIV-infected patients.

There are many decisions for which management must consider the broad interests of society at large (all stakeholders) in addition to the interests of the stockholders. One such situation is management's handling of decisions that could cause environmental damage. This paper will discuss the nature of the conflicts of interest between management and all stakeholders and how these conflicts affect the firms' incentives to disclose their responsibility for environmental liabilities. When faced with the choice of acting in the interest of current shareholders or society at large, management appears unwilling to disclose its responsibility for environmental cleanup in order to convince society that its interests are being protected. Businesses, as a group, have a massive responsibility to clean up environmentally damaged, hazardous sites. This responsibility leads to a large expected aggregate obligation (estimated in the hundreds of billions of dollars) for cleanup of environmental damage; however, there are many questions regarding how this responsibility is being accepted and communicated (reported) by the individual firms. Therefore, there is a discrepancy between the expected aggregate environmental obligation and the sum of the individual obligations as reported by firms.

Resume La proteine S-100B est une proteine acide specifique des cellules gliales. Les premieres etudes suggerent que S-100B pourrait etre un marqueur tissulaire, reflet des dommages cerebraux. Le but de cette etude etait de correler S-100B au score de Glasgow lors de la prise en charge initiale du neurotraumatise par le SMUR. Apres accord du CCPPRB de notre institution, 23 patients consecutifs neurotraumatises pris en charge par le SMUR ont ete inclus dans cette etude prospective. Les parametres etudies etaient le score de Glasgow sur les trois items classiques (Gy, Gv, et Gm) apres stabilisation respiratoire te hemodynamique en prehospitalier. Un premier prelevement veineux etait realise lors de la mise en condition (Cs1) puis un second lors de l'arrivee dans l'unite d'hospitalisation (Cs2). Le dosage serique etait realise par une technique d'immunoluminometrie et chimiluminescence (Byk-Sangtec Diagnostica, commercialise en France par Nichols Institute Diagnostics). Le seuil de detection est de 0,02 μg/L pour une normale inferieure a 0, 12 μg/L. Les concentrations de S-100B a Cs1 et Cs2 ont ete correlees (Spearman) a G, Gy, Gv, Gm et comparees par un test de Wilcoxon. L'âge moyen (± DS) des patients inclus est de 35 ± 8 ans. G moyen est 10 ± 5. La valeur de Cs2 est significativement plus basse que celle de Cs1. Enfin, il n'existe pas de correlation entre Cs1, Cs2, G, Gy, Gv, et Gm. L'augmentation importante de S-100B (en moyenne 43 fois la normale a Cs1 suggere que cette proteine est un marqueur lesionnel cerebral. La cinetique tres rapide de decroissance (Cs2 n'est plus que 26 fois la normale) laisse presager d'un pic plasmatique post-traumatique tres precoce. Neanmoins, il n'existe pas de correlation entre le score de Glasgow initial et la concentration serique de S-100B.

A new series of substituted 2-anilino-3-methylbutyrates has been prepared; bioassay data for these compounds on Heliothis virescens, Musca domestica, Aphis fabae and Tetranychus urticae are presented and discussed. Some unexpected relationships were observed between the nature of the substituents and the biological activity. Increases in foliar stability were noted with certain substitution patterns. Both α-cyano-3-phenoxybenzyl 3-methyl-2-(α, α, α,2-tetrafluoro-p-toluidino)butyrate and the corresponding 2-(2-chloro-α, α, α-trifluoro-p-toluidino)-3-methylbutyrate showed good stability in air and light, and exhibited biological activities of a similar nature and potency to those of previously known synthetic pyrethroids. Esters of the (R)-2- anilino-3-methylbutyric acids are far more active than those prepared from the (S)-enantiomers. The (R)-configuration at C-2 in these acids is sterically equivalent to the active absolute configuration at the chiral carbon α to the carboxylate group in both the permethrin and the fenvalerate types of pyrethroids. A new class of insecticidal 2-(isoindolin-2-yl)alkanoates is also reported. In this series the most biologically active analogue was α-cyano-3-phenoxybenzyl 3-methyl-2-(4,5,6,7-tetrafluoroisoindolin-2-yl)butyrate. These esters were considerably less stable than the anilino analogues on exposure to air and light.

Three analogues of 3,3-dimethyl-2-propenol (dimethylallyl alcohol) were synthesized and found to possess anti juvenile hormone activity when assayed on lepidopterous insect species (particularly the tobacco hornworm, Manduca sexta). The most active compound of those described, 3,3-dichloro-2-propenyl hexanoate, caused precocious metamorphosis, inhibited juvenile hormone (JH) biosynthesis in vitro, and reduced JH titers in vivo.

An empirical constraint for the determination of the force constants of a General Valence Force Field for the tetrahedral halides with the general formula AX4 n (where A = an element of the groupe II, III, IV, V and VI; X = F, Cl, Br and I and n = +1, 0, -1 and -2) is presented. The model is defined by a constant value of the parameter p= (ft -ftt) / (ft + 3ftt). The optimum value, p = 0.73, obtained for the mixed halides of chlorobromomethane is compared with those calculated from other force fields commonly used.

The potential of analogues of insect juvenile hormones (JHs) for pest control has been demonstrated by the application of methoprene for the selective control of certain insects, including several mosquito species, the cigarette beetle and the hornfly1. Compounds that impede JH production could offer a potentially more attractive method of control because accelerated metamorphosis would shorten the lifetime of the larvae, the stage that usually does maximum damage to the host plant. Of the few anti-juvenile hormone (AJH) agents described2–5, only precocenes evoke all the required biological responses, but they affect a few insect taxa of minor economic importance. Their activity is thought to result from cytotoxicity6,7 in the corpora allata. In view of similarities between the biosynthesis of the carbon skeletons of insect JHs8,9 and farnesyl pyrophosphate (a precursor of steroids and other terpenoids10), compounds that inhibit the early steps in the biosynthesis of cholesterol might be expected to suppress JHs. Although this concept has already been explored without success11,12, we now report the inhibition of juvenile hormone biosynthesis (AJH activity, see Table 1 legend) by a fluorinated mevalonate tetrahydro-4-fluoromethyl-4-hydroxy-2H-pyran-2-one, FMev, Fig. 1) which until now was known only to be hypocholesterolaemic13–15.

THE widespread occurrence of resistance to present-day insecticides among pest species1,2 has prompted intensive research into alternative means of insect control. The discovery that application of the insect juvenile hormone (JH) or its mimics at certain critical stages of the life cycle leads to developmental abnormalities and death3 has raised hopes of the emergence of a “third generation” of pesticide chemicals4. It has been suggested that insects would be unable to develop resistance to their own juvenile hormone3. Arguments have also been advanced that resistance to hormonal insecticides is not unlikely5,6.

The optical isomers (9) and (13) of the insect anti-juvenile hormone, (�)-ethyl p-[2-(t-butylcarbonyloxy)butoxy]benzoate (ETB) (14), have been synthesized and their biological activities examined in the tobacco hornworm Manduca sexta. It was found that the observed anti-juvenile hormone activity at low dose levels and juvenile hormone activity at higher levels in the Manduca sexta, after topical treatment with the racemic mixture (14) is due entirely to the (–)-enantiomer (9), the (+)-enantiomer (13) being completely inactive.

International audience; OBJECTIVE: To determine the concomitant incidence, molecular diversity, management and outcome of nosocomial candidemia and candiduria in intensive care unit (ICU) patients in France. DESIGN: A 1-year prospective observational study in 24 adult ICUs. PATIENTS: Two hundred and sixty-two patients with nosocomial candidemia and/or candiduria. MEASUREMENTS AND RESULTS: Blood and urine samples were collected when signs of sepsis were present. Antifungal susceptibility of Candida strains was determined; in addition, all blood and 72% of urine C. albicans isolates were analyzed by using multi-locus sequence type (MLST). The mean incidences of candidemia and candiduria were 6.7 and 27.4/1000 admissions, respectively. Eight percent of candiduric patients developed candidemia with the same species. The mean interval between ICU admission and candidemia was 19.0[Symbol: see text]+/-[Symbol: see text]2.9 days, and 17.2[Symbol: see text]+/-[Symbol: see text]1.1 days for candiduria. C. albicans and C. glabrata were isolated in 54.2% and 17% of blood and 66.5% and 21.6% of urine Candida-positive cultures, respectively. Fluconazole was the most frequently prescribed agent. In all candidemic patients, the prescribed curative antifungal agent was active in vitro against the responsible identified strain. Crude ICU mortality was 61.8% for candidemic and 31.3% for candiduric patients. Seventy-five percent of the patients were infected with a unique C. albicans strain; cross-transmission between seven patients was suggested in one hospital. CONCLUSIONS: Candidemia is late-onset ICU-acquired infection associated with high mortality. No difference in susceptibility and genetic background were found between blood and urine strains of Candida species.