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Abstract Background In emergency medicine, pain is a frequent reason for consultation. However, there is a great variation in its management which is often insufficient. The use intravenous morphine alone or multimodal analgesia with paracetamol is recommended for severe pain. But robust data are lacking to justify the association of paracetamol with morphine versus morphine alone for pain management in the emergency room (ER). The aim of our study is therefore to assess if in patients with acute pain of moderate to severe intensity with a numerical verbal scale (NVS) ≥5 in the ER, the intravenous administration of morphine alone is not inferior to the administration of intravenous morphine combined with paracetamol at 30 min from the first administration of the study drug. Methods ADAMOPA is a prospective, non-inferiority, multicenter, placebo-controlled, parallel-group, randomized (1:1), double-blind trial. Subjects will be enrolled in the ER if they experience moderate to severe, acute, non-traumatic, and traumatic pain, defined as an NVS ≥5. The primary endpoint will be the between-group difference in mean change in NVS pain scores among patients receiving the combination of intravenous morphine plus paracetamol or intravenous morphine given alone, measured from the time before administration of the study medication to 30 min later. Discussion This trial will determine the clinical utility of the association of paracetamol with morphine for pain management in the emergency room. The ADAMOPA trial will be conducted in accordance with the International Council on Harmonization Good Clinical Practices. Trial registration EudraCT number: 2019-002149-39. ClinicalTrials.gov identifier: NCT04148495. Date of trial registration: November 1, 2019.

This article questions from a comparative perspective, the pedagogy and content of Qur’anic teachings within two institutions in Fez – the old Mosque-University of al-Qarawiyyine on the one hand, and on the other hand, university departments for Islamic Studies (dirāsāt islāmiyya) and Islamic Law (sharīʿa) – and how these sectors reflect an official doctrine which advocates at the same time “modernization” and reform, and a traditionalist Islam focused on legal aspects. Our study is particularly interested in the portrait of a teacher in a cross-over setting, who practices in both types of institution in the city.

Abstract Background Rapid access to emergency medical communication centers (EMCCs) is pivotal to address potentially life-threatening conditions. Maintaining public access to EMCCs without delay is crucial in case of disease outbreak despite the significant increased activity and the difficulties to mobilize extra staff resources. The aim of our study was to assess the impact of two-level filtering on EMCC performance during the COVID-19 outbreak. Methods A before-after monocentric prospective study was conducted at the EMCC at the Nantes University Hospital. Using telephone activity data, we compared EMCC performance during 2 periods. In period one (February 27th to March 11th 2020), call takers managed calls as usual, gathering basic information from the caller and giving first aid instructions to a bystander on scene if needed. During period two (March 12th to March 25th 2020), calls were answered by a first-line call taker to identify potentially serious conditions that required immediate dispatch. When a serious condition was excluded, the call was immediately transferred to a second-line call taker who managed the call as usual so the first-line call taker could be rapidly available for other incoming calls. The primary outcome was the quality of service at 20 s (QS20), corresponding to the rate of calls answered within 20 s. We described activity and outcome measures by hourly range. We compared EMCC performance during periods one and two using an interrupted time series analysis. Results We analyzed 45,451 incoming calls during the two study periods: 21,435 during period 1 and 24,016 during period 2. Between the two study periods, we observed a significant increase in the number of incoming calls per hour, the number of connected call takers and average call duration. A linear regression model, adjusted for these confounding variables, showed a significant increase in the QS20 slope (from − 0.4 to 1.4%, p = 0.01), highlighting the significant impact of two-level filtering on the quality of service. Conclusions We found that rapid access to our EMCC was maintained during the COVID-19 pandemic via two-level filtering. This system helped reduce the time gap between call placement and first-line call-taker evaluation of a potentially life-threatening situation. We suggest implementing this system when an EMCC faces significantly increased activity with limited staff resources.

Fresh carrot juice presents nutritional and organoleptic qualities which have to be preserved. However, it is a fast perishable beverage, and its low-acidic pH promotes the development of foodborne pathogens and spoilage microorganisms. This study aims to assess the modification and variability of physicochemical and microbial indicators during storage of carrot juice, and to isolate and select microorganisms to be used as promoters of spoilage to quantify the effect of preservation treatments. To achieve that, 10 batches of carrot Daucus carota cv. Maestro juice were prepared independently, stored up to 14 days at 4 °C and analyzed. Volatile compound composition differed mainly according to the analyzed batch. During storage, an increase of the content of ethanol, ethyl acetate or 2-methoxyphenol, which are produced by different microorganisms, was noticed. Isolation of bacteria revealed Pseudomonas, lactic acid bacteria, and enterobacteria, some of them provoking odor modification of carrot juice at 4 °C. Assays in carrot juice with isolated yeasts and molds showed the ability of Meyerozyma guillermondii to induce texture modification and some isolates, e.g., Pichia guillermondii, resulted in gas production. Selected isolates able to induce spoilage are useful to test preservative treatments of fresh carrot juice under controlled conditions.

Abstract Background Acute pain is a common condition among prehospital patients and prompt management is pivotal. Opioids are the most frequently analgesics used in the prehospital setting. However, opioids are highly addictive, and some patients may develop opioid dependence, even when they are exposed to brief opioid treatments. Therefore, alternative non-opioid analgesia should be developed to manage pain in the prehospital setting. Used at subdissociative doses, ketamine, a noncompetitive N-methyl-D-aspartate and glutamate receptor antagonist, provides analgesic effects accompanied by preservation of protective airway reflexes. In this context, we will carry out a randomized controlled, open-label, multicenter trial to compare a subdissociative dose of ketamine to morphine to provide pain relief in the prehospital setting, in patients with traumatic and non-traumatic pain. Methods/design This will be a multicenter, single-blind, randomized controlled trial. Consecutive adults will be enrolled in the prehospital setting if they experience moderate to severe, acute, non-traumatic and traumatic pain, defined as a numeric rating scale score greater or equal to 5. Patients will be randomized to receive ketamine or morphine by intravenous push. The primary outcome will be the between-group difference in mean change in numeric rating scale pain scores measured from the time before administration of the study medication to 30 min later. Discussion This upcoming randomized clinical trial was design to assess the efficacy and safety of ketamine, an alternative non-opiate analgesia, to manage non-traumatic and traumatic pain in the prehospital setting. We aim to provide evidence to change prescribing practices to reduce exposition to opioids and the subsequent risk of addiction. Trial registration ClinicalTrials.gov, ID: NCT03236805. Registered on 2 August 2017.

Abstract Background Expression of SRY [sex-determining region Y]-box11 (SOX11) is specific to mantle cell lymphoma (MCL) and contributes, in conjunction with immunoglobulin variable heavy chain gene mutation status, to the identification of two forms of this disease. Methods The aim of this report was firstly, to design an easy and suitable RT-qPCR method to quantify SOX11 mRNA expression in mantle cell lymphoma and other B cell malignancies with the proper reference gene; secondly, to define the best threshold of relative quantity of SOX11 mRNA in order to reach the best compromise between sensitivity and specificity. Results For best discrimination of MCL and non-MCL groups we determined an area under the curve (AUC) of 0.9750 and a threshold of 1.76 with 100% sensitivity and 88% specificity. AUC and threshold values of respectively 0.91/1.346 [87% sensitivity, 80% specificity] and 0.9525/1.7120 [100% sensitivity, 88% specificity] for GAPDH and RPLP0 respectively denote that the RPLP0 reference gene alone is sufficient for PCR housekeeping gene. Conclusion This work describes an RT-qPCR assay for SOX11 expression in order to better characterize MCL at diagnosis. Further studies on larger cohorts are needed to evaluate this molecular tool, especially for the follow-up of minimal residual disease.

Amongst the microbial diversity in the food chain, lactic acid bacteria (LAB) are in the front row for their positive roles [...]

Fruitlet Core Rot (FCR) is a fungal disease that negatively impacts the quality of pineapple, in particular the ‘Queen Victoria’ cultivar. The main FCR causal agent has been identified as Fusariumananatum. This study focused on the correlation between FCR disease occurrence, fungal diversity, and environmental factors. FCR incidence and fungal species repartition patterns were spatially contextualized with specific surrounding parameters of the experimental plots. The mycobiome composition of healthy and diseased fruitlets was compared in order to search for potential fungal markers. A total of 240 pineapple fruits were sampled, and 344 fungal isolates were identified as belonging to 49 species among 17 genera. FCR symptom distribution revealed a significant gradient that correlated to that of the most abundant fungal species. The association of wind direction and the position of proximal cultivated crops sharing pathogens constituted an elevated risk of FCR incidence. Five highly represented species were assayed by Koch’s postulates, and their pathogenicity was confirmed. These novel pathogens belonging to Fusariumfujikuroi and Talaromycespurpureogenus species complexes were identified, unravelling the complexity of the FCR pathosystem and the difficulty of apprehending the pathogenesis over the last several decades. This study revealed that FCR is an airborne disease characterized by a multi-partite pathosystem.

Minimally-processed pineapple stored under refrigerated conditions is highly perishable. We aimed to characterize the evolution of physicochemical, sensory and microbiological quality during cold storage. Pineapple batches were sampled from several locations in Reunion Island and then minimally processed. In the processing step, the variability of firmness and counts of yeasts and molds were observed. Moreover, correlations between the sampling season and pH and b* color component, as well as between fungal population and b* parameter were observed. During storage, the visual aspect of pineapple cuts changed to brown and shiny, whereas olfactive descriptors shifted from fruity descriptors and fresh to fermented, alcoholic and milky. The values for pH, TA and TSS did not significantly vary according to storage time. A decrease in firmness and C* color parameter was observed. Yeast and mold counts were significantly higher after 7 days of storage. The diversity in yeasts and molds was mainly dependent on the considered batches observed from PCR-DGGE profiles. Fungal species were isolated from spoiled pineapple cuts. The implication of Penicilllium citrtrinum, Talaromyces amestolkiae, Rhodotorula mucilaginosa, Saccharomyces cerevisiae, and Meyerozyma caribbica in the spoilage of minimally-processed pineapple cuts was further demonstrated.

Abstract The aim of this Letter to the Editor was to report a strategy to reduce time waiting for emergency calls in a dispatch center, in line with a recently published article that reviewed evidence for medical dispatching systems to accurately dispatch Emergency medical Services. Here, we tested the effect of a connected distribution of calls, where a call is allocated to the first available resource among a pooled group of telecommunicators from several dispatch centers. We found that connect dispatch centers improve dispatch center performance, especially during an overloaded period. It could be leveraged to handle emergency calls without delay and to appropriately dispatch Emergency Medical Services.

Blastic plasmacytoid dendritic cell neoplasm is an aggressive hematologic malignancy with a poor prognosis. No consensus regarding optimal treatment modalities is currently available. Targeting the nuclear factor-kappa B pathway is considered a promising approach since blastic plasmacytoid dendritic cell neoplasm has been reported to exhibit constitutive activation of this pathway. Moreover, nuclear factor-kappa B inhibition in blastic plasmacytoid dendritic cell neoplasm cell lines, achieved using either an experimental specific inhibitor JSH23 or the clinical drug bortezomib, interferes in vitro with leukemic cell proliferation and survival. Here we extended these data by showing that primary blastic plasmacytoid dendritic cell neoplasm cells from seven patients were sensitive to bortezomib-induced cell death. We confirmed that bortezomib efficiently inhibits the phosphorylation of the RelA nuclear factor-kappa B subunit in blastic plasmacytoid dendritic cell neoplasm cell lines and primary cells from patients in vitro and in vivo in a mouse model. We then demonstrated that bortezomib can be associated with other drugs used in different chemotherapy regimens to improve its impact on leukemic cell death. Indeed, when primary blastic plasmacytoid dendritic cell neoplasm cells from a patient were grafted into mice, bortezomib treatment significantly increased the animals’ survival, and was associated with a significant decrease of circulating leukemic cells and RelA nuclear factor-kappa B subunit expression. Overall, our results provide a rationale for the use of bortezomib in combination with other chemotherapy for the treatment of patients with blastic plasmacytoid dendritic cell neoplasm. Based on our data, a prospective clinical trial combining proteasome inhibitor with classical drugs could be envisaged.