Search

Objectives: We assessed the contamination with Legionella pneumophila (Lp) of the hot water network (HWN) of a hospital, mapped the risk of contamination, and evaluated the relatedness of isolates. We further validated phenotypically the biological features that could account for the contamination of the network., Methods: We collected 360 water samples from October 2017 to September 2018 in 36 sampling points of a HWN of a building from a hospital in France. Lp were quantified and identified with culture-based methods and serotyping. Lp concentrations were correlated with water temperature, date and location of isolation. Lp isolates were genotyped by pulsed-field gel electrophoresis and compared to a collection of isolates retrieved in the same HWN two years later, or in other HWN from the same hospital., Results: 207/360 (57.5%) samples were positive with Lp. In the hot water production system, Lp concentration was negatively associated with water temperature. In the distribution system, the risk of recovering Lp decreased when temperature was >55 °C (p < 10 -3 ), the proportion of samples with Lp increased with distance from the production network (p < 10 -3 ), and the risk of finding high loads of Lp increased 7.96 times in summer (p = 0.001). All Lp isolates (n = 135) were of serotype 3, and 134 (99.3%) shared the same pulsotype which is found two years later (Lp G). In vitro competition experiments showed that a 3-day culture of Lp G on agar inhibited the growth of a different pulsotype of Lp (Lp O) contaminating another HWN of the same hospital (p = 0.050). We also found that only Lp G survived to a 24h-incubation in water at 55 °C (p = 0.014)., Conclusion: We report here a persistent contamination with Lp of a hospital HWN. Lp concentrations were correlated with water temperature, season, and distance from the production system. Such persistent contamination could be due to biotic parameters such as intra-Legionella inhibition and tolerance to high temperature, but also to the non-optimal configuration of the HWN that prevented the maintenance of high temperature and optimal water circulation., Competing Interests: Declaration of competing interest None of the authors have anything to disclose., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Resistance Nodulation cell Division (RND) efflux pumps are known to contribute to the tolerance of Pseudomonas putida to aromatic hydrocarbons, but their role in antibiotic resistance has not been fully elucidated. In this study, two types of single-step multidrug-resistant (MDR) mutants were selected in vitro from reference strain KT2440. Mutants of the first type were more resistant to fluoroquinolones and β-lactams except imipenem, and overproduced the efflux system TtgABC as a result of mutations occurring in regulator TtgR. In addition to TtgABC, mutants of the second type such as HPG-5 were found to upregulate a novel RND pump, dubbed ParXY/TtgC, which accommodates cefepim, fluoroquinolones and aminoglycosides. As demonstrated by gene deletion experiments, TtgABC and ParXY/TtgC are both under the positive control of a two-component system, PpeRS. Whole-genome sequence analyses revealed that mutant HPG-5 harbours a mutation inactivating the gene (sucD) of succinyl-CoA synthetase, an enzyme of the tricarboxylic cycle. Disruption of sucD in strain KT2440 reproduced the resistance phenotype of HPG-5, and activated the glyoxylate shunt. Finally, identification of two MDR clinical strains of P. putida that jointly overexpress TtgABC and ParXY/TtgC, of which one is a sucD mutant, highlights the role of these efflux systems as determinants of antibiotic resistance., (© 2020 Society for Applied Microbiology and John Wiley & Sons Ltd.)

Aim: We aimed to evaluate the accuracy of the dosage of calprotectin in ascitic fluid (AF) using the Quantum Blue assay, for the prompt diagnosis of spontaneous bacterial peritonitis (SBP)., Methods: We prospectively collected 236 AF samples from 119 cirrhotic patients hospitalized in two French centers between May 2016 and May 2017. Bloody and chylous/cloudy AF, and secondary peritonitis were excluded. SBP was diagnosed if neutrophils in AF were >250/mm 3 using standard cytology. The Quantum Blue Reader selectively measured the calprotectin antigen (MRP8/14) in 12 min within the measurable range from 0.18 to 1.80 μg/mL; values outside this range were registered as 0.17 and 1.81 μg/mL., Results: A total of 36 AF were considered as SBP (15.2%). SBP had higher median levels of calprotectin than non-SBP (1.81 vs. 0.25 μg/mL, P < 0.001). Calprotectin levels were positively correlated with neutrophils in AF (r = 0.57, P < 0.001) and C-reactive protein (r = 0.43, P < 0.001), but not with the Child-Pugh and Model for End-Stage Liver Disease scores. The optimal threshold of calprotectin to diagnose SBP was set at 1.51 μg/mL (80th percentile of calprotectin), yielding sensitivity, specificity, and positive and negative predictive values of 86.1%, 92.0%, 65.9%, and 97.3%, respectively. Only one asymptomatic patient with SBP had a low calprotectin level, but a high serum C-reactive protein level that strongly suggested an ongoing infection. We also showed that intraclass correlation coefficients for inter- and intra-observer agreement were excellent, with 0.95 and 0.89, respectively., Conclusions: The dosage of calprotectin in AF using the Quantum Blue assay is a rapid and reliable method of ruling out SBP in hospitalized cirrhotic patients., (© 2018 The Japan Society of Hepatology.)

Extruded cereals mainly composed of starch and enriched in fibers were produced with two types of base recipes: (i) one recipe mainly composed of wheat flour and (ii) one recipe mainly composed of corn and soya flours. The addition of fibers was performed through the use of oat bran concentrate or wheat bran, up to 32% of the recipe. The structure of the extrudates, assessed by X-ray tomography, pointed out the decrease of porosity and of mean cells size with the increase of the total dietary fibers content of the recipe. The hardness of the products, i.e. the maximum stress determined by a compression test, was linked to their porosity. The Gibson-Ashby relationship could be applied and the fit was even improved when considering the walls of the solid foam as composite materials. Fibers and proteins can be indeed considered as particles dispersed in the starchy phase. This work thus shows the impact of the structure of the extrudates on their mechanical properties. The structure is taken into account at different length scales; at the level of the porous structure and at the level of the phase of the main biopolymers present in the recipe (starch, proteins and fibers). The mechanical behavior of these products is then discussed according to their characteristics of composite solid foams., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Tetanus toxoid was used as a model antigen for the immunization of Macaca fascicularis. Using peripheral blood as a template, specific Fab-encoding genes were amplified by PCR on the fourth day after the final boost, and cloned in a phagemidic vector (pComb3X) as a small immune library (5 x 10(5) clones). A high-affinity Fab (Kd = 4 x 10(-10) M), 6-ATT, was isolated from this library by panning. The genes encoding 6-ATT were found to be similar to human immunoglobulin germline genes, and were assigned to subgroups of human V, (D) or J genes by IMGT/V-QUEST. Overall, the Fab variable domain framework regions were 93% identical to the representative genes and alleles of the human subgroups, this level of identity being similar to that between genes of the same human subgroup. This strategy could be used for the isolation of high-affinity, human-like Fab fragments directed against numerous antigens.

Many authors use a preliminary orthopedic procedure before cleft lip and palate surgical closure in order to prevent possible bone distortion following the rupture of the muscle belts resulting from the cleft. Actually, this is generally not only an orthopedic treatment but rather a surgical orthopedic step which includes lip adhesion before the surgical closure of the clefts. Following the procedures proposed by Georgiade and Latham, we have used since 1996 a treatment based on traction applied with an elastic chain on splints attached by transmaxillary pins for certain types of clefts, namely unilateral complete clefts with endognathy of the small fragment, unilateral complete clefts larger than 7 mm, bilateral wide complete clefts with premaxilla protrusion, and bilateral wide complete clefts with collapsus and premaxillary protrusion. Technical procedures vary with the type of cleft. Standard procedures with or without jacks are used for the other types of complete clefts. These orthopedic procedures with elastic traction are performed between the 3rd and 6th week, before lip adhesion of the upper part of the lip (combined with release of skin and subcutaneous tissues from the underlying alar cartilage). A palatine plate with or without a jack, fitted most of the time with a spring for nostril support, is then inserted until surgical closure.

Usual imaging diagnostic for salivary glands is sialography. Sialography is not stripped of disadvantages and failures. The MRI-sialography is an examination which is carried out without any injection of contrast's product (without catheterization or intravenous injection). It is thus noninvasive and painless. The complete study of salivary gland and its ducts is always possible and could not be blocked by local or loco-regional conditions. It allows exploration of several salivary glands in the same time. We think that the MRI-sialography must find its place in the diagnosis arsenal for salivary pathology in spite of its current handicaps represented by its cost and the difficulty of access to the apparatuses.

The authors describe the main techniques for rapid prototyping used in the medical field, with particular emphasis on Laser stereolithography. They describe the basics of the technique as well as the procedures they currently use to construct anatomic specimens from scanned images. For more than 10 years, the targets of researchers in the field of bone reconstruction in craniofacial surgery have been: to design a system to acquire data directly from CT-scans, to optimize modelling, processing and materials, to verify the possibility of producing prefabricated prostheses with data from preoperative models (22 cases). The target of integrating this technique into therapeutic protocols has been reached. The current trend in research is to produce prostheses from biocompatible materials directly from CT scan data by Laser stereolithography.

Objective: Infravesical obstruction can occur after surgical cure for urinary stress incontinence (USI). Apart from palliative treatments with limited effects, this iatrogenic complication can be corrected by complete urethrolysis. The various indications and techniques of this surgery are presented., Method: Urethrolysis is designed to release the urethra and bladder neck and can be performed via a transvaginal or retropubic approach. Some authors then recommend resuspension of the bladder neck, while others use a Martius or omentum flap to reduce the risk of restenosis., Results: The success of urethrolysis is measured by the return of normal micturition with complete disappearance of the irritating and/or obstructive symptoms. The success rate for the transvaginal procedure varies from 65% to 92% according to different teams, while the success rate via an abdominal incision was 93% in one series., Conclusion: Urethrolysis is a difficult surgical technique, whose long-term results have not yet been precisely determined. The transvaginal route is associated with a low morbidity and remains our personal preference to release the obstructed urethra after operation for USI.

Complete destruction of the urethra is one of the long-term complications of continuous bladder catheterization in women with advanced neurogenic bladder, resulting in a continuous urine leak around the catheter. This type of incontinence can be treated by closure of the bladder neck associated with suprapubic bladder drainage. Several approaches hve been proposed: abdominal, vaginal and mixed abdominal-vaginal. Each of these techniques is described, together with their results. Closure of the bladder neck decreases the nursing care, reduces the risk of perineal infectious and cutaneous complications and improves the patient's quality of life. Ileal urinary diversion is not always possible in these patients who often have a poor general status. Transvaginal closure of the bladder neck therefore constitutes one of the treatment options.

The Martius pedicle adipose flap can be used as an interposition flap during complex vaginal operations. It is a simple, rapid technique allowing raising of a well vascularized adipose flap with a mean length of 8 to 12 cm. It can be used in certain forms of vaginal repair, such as high supratrigonal vesicovaginal fistula, after bladder perforation, for obstructed urethra after colposuspension, after urethral destruction following prolonged bladder catheterization in a neurological patient, during repair of a complex urethral diverticulum or during transvaginal insertion of an artificial sphincter. After describing the flap raising operative technique, the various operative indications are presented.

Objectives: We report our experience of renal and/or adrenal manifestations of von Hippel-Lindau disease and propose a practical approach., Methods: Eight patients (mean age: 43 years) presented with predominant renal and adrenal lesions in 6 cases and 2 cases, respectively., Results: All patients are alive with a mean follow-up of 8.1 years. A local recurrence after partial nephrectomy was observed in two cases. Two patients are in renal failure and are treated by dialysis and two patients require hormone replacement therapy for adrenal insufficiency., Conclusions: The predegenerative nature of simple renal was not observed. Conservative renal surgery is adapted to small renal tumours, with a low cytological grade and without any distant lesions in the same kidney. Radical nephrectomy is reserved for large lesions (greater than 5 cm) with a high cytological grade. The presence of pheochromocytoma must be systematically excluded. Preservation of the adrenal gland in the case of homolateral renal surgery for cancer is recommended. The reliability of the genetic test allows early diagnosis of this disease.

Metastases of renal cell carcinoma are exceptional in the spermatic cord and epididymis (17 cases reported in the literature). The authors report two cases of metastases occurring 30 and 44 months after radical nephrectomy, respectively. Both patients are alive without metastases after surgical resection, with a follow-up of 4 and 8 years after the diagnosis of renal cancer, respectively. The mechanism of development, usually retrograde venous spread, and the particular features of these metastatic sites are discussed.

The development of helicoidal CT acquisition allows 3D reconstruction of vessels, cavities or parenchyma of mobile organs such as the kidney. The value of this 3D surface reconstruction was investigated in various areas of urology: congenital malformations (horseshoe kidney, megaureter, ectopic organs), acquired malformations (diverticulum, trabeculated bladder), renal stones, particularly staghorn calculi, and renal transplantation. The fields of interest of 3D CT scans are still poorly defined, but are probably threefold: diagnostic, therapeutic and for teaching purposes. 3D representation completes classical axial scans and, in some cases, competes with other more invasive imaging techniques.