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This study employs qualitative methodology to assess surgeons' perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making.The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strategies to enact broad acceptance of guidelines for surgery are hindered because of a knowledge gap in understanding surgeons' current attitudes and opinions.We performed semi-structured interviews with board-certified North American general and colorectal surgeons who manage recurrent diverticulitis. We purposely sampled specialists by both surgeon and practice factors. An iterative inductive/deductive strategy was used to code and analyze the interviews and create a conceptual framework.25 surgeons were enrolled over a nine-month period. There was diversity in surgeons' gender, age, experience, training, specialty (colorectal vs general surgery) and geography. Surgeons described the difficult process to determine who receives an operation. We identified seven major themes as well as twenty subthemes of the decision-making process. These were organized into a conceptual model. Across the spectrum of interviews, it was notable that there was a move over time from decisions based on counting episodes of diverticulitis to a focus on improving quality of life. Surgeons also felt that quality of life was more dependent on psychosocial factors than the degree of physiological dysfunction. [What about what surprised you/].Surgeons mostly have discarded older dogma in recommending colectomy for recurrent diverticulitis based on number and severity of episodes. Instead, decision making in recurrent diverticulitis is complex, involving multiple surgeon and patient factors and evolving over time. Surgeons struggle with this decision and education- or communication-based interventions that focus on shared decision making warrant development.

Research confirms the heterogeneous nature of patient challenges during recovery from the ICU and supports the need for modifying care experiences, but few data are available to guide clinicians seeking to support patients' individual recovery trajectories.What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU recovery clinic (ICU-RC)?We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the southeastern United States. The sample included 19 patients and 13 caregivers (≥ 18 years of age) attending a telemedicine ICU-RC visit after critical illness resulting from septic shock or ARDS. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches.Two themes were identified from the patient-provider dialogue: (1) problem identification and (2) problem-solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health-care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance.Patients surviving a critical illness experience a complexity of problems that may be addressed best by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues, we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery.ClinicalTrials.gov; No.: NCT03926533; URL: www.gov.

Telehealth is the use of electronic information and technology for long-distance clinical care. In direct-to-patient (DTP) telehealth, the patient initiates care from a personal computer or mobile device to a medical provider. While information on standard clinic-to-clinic telehealth exists, less is known about DTP telehealth in pediatric populations. Using quantitative and qualitative data, we examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers.Telehealth visits for acute and preventive care took place from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). Patients and primary care providers conducted the visit through the clinic's portal or other platforms (WhatsApp, FaceTime, Zoom). Providers completed an electronic survey with patient feedback about the telehealth experience and their own observations. An iterative inductive/deductive approach informed a coding scheme for free-text survey responses consisting of five domains.REDCap surveys were completed for 258 (52%) of telehealth visits. There was an overrepresentation of English visits compared to the overall clinic population and the majority of visits were via mobile phone. Visits with English speakers utilized the patient portal and had positive process ease ratings more often than those with non-English speakers. Providers rated most telehealth visits as satisfactory, with contributing elements including family call environment, technology process and experience, value added, and barriers.Expanding telehealth in pediatrics without worsening health disparities requires building digital health that is user-friendly on mobile technology, facilitating patient preferred language, and simplifying logistical processes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tissue specimens are valuable materials for microbiological diagnosis. The method of tissue processing can have a significant effect on sensitivity. This study aimed to compare different biopsy processing methods in terms of efficacy and standardization. Pork tissue artificially inoculated with Staphylococcus aureus and Escherichia coli, and samples of infected human tissue were processed by different methods before culture, and the results compared. Bacterial recovery from artificially inoculated pork tissue was significantly higher by homogenization with GentleMacs Dissociator than with sonication. No significant difference was observed between the GentleMacs Dissociator and manual treatment with a scalpel and vortexing. The microbial yield from homogenized human tissues was significantly higher after homogenization with GentleMacs Dissociator than with the conventional method. Homogenization with the GentleMacs Dissociator retrieves bacteria from tissue effectively. Tissue homogenization with the Dissociator is easy and fast to perform and allows for a high degree of standardization.

Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low ( Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.

Recovery of severely deformed ferrite was followed in situ by High Energy X Ray Diffraction during heating and isothermal holding experiments. Dislocation densities during annealing were determined by a modified Williamson Hall method. The deduced recovery kinetics was compared to post-mortem hardness measurements. A temperature dependent saturation of recovery was exhibited during holding. Dislocation density drop and saturation behavior cannot be reproduced simultaneously by the classical physically based models.

International audience; Knowledge of phase transformation kinetics is a key point in designing steel grades, in particular modern high-performance grades, highly sought-after in energy and transportation applications. The design space for these grades is highly multi-dimensional given the numerous potential alloying elements. The characterization techniques that are usually relied on to assess transformation kinetics, such as metallography or dilatometry, are highly time consuming, due to their limitation to either a single transformation time or a single composition per experiment. The high-throughput approach showcased here overcomes those limitations by combining compositionally graded samples with time-and space-resolved in situ Xray diffraction, yielding full kinetic records over a range of compositions in a single run. Its application to low-alloy steel required addressing specific challenges related to the reactivity and thermodynamics of the material. The transformation of austenite into ferrite was chosen to illustrate its benefits. Using the rich resulting database, the transformation mechanism was examined quasi-continuously across sections of the composition space. Neither the paraequilibrium, nor the local equilibrium with negligible partitioning model, nor a transition from the former to the latter is applicable over the whole range of investigated conditions. Instead, the observed kinetics were explained by accounting for the solute drag exerted on the mobile interface. This work is a major contribution in accelerating the design of future low-alloy steel grades, involving the transformation of austenite into ferrite or any other transformation to which the present high-throughput methodology can be adapted.

Acta materialia 212, 116920 (2021). doi:10.1016/j.actamat.2021.116920, The manufacturing of Dual-Phase steels includes as a crucial step the annealing of a cold-rolled ferrite-pearlite (F/P) microstructure, which involves numerous and interacting metallurgical mechanisms, namely recovery/recrystallization of ferrite, globularization, manganese enrichment, coarsening of cementite and finally austenite transformation. Present study focuses on the austenite transformation considering its interaction with the ferrite recrystallization and the influence of the chemical composition of the cementite. The behavior of a cold-rolled F/P microstructure is studied at three heating rates to induce weak and strong interactions between the mechanisms, in particular using post mortem microstructure observations but also in situ High Energy X-Ray Diffraction experiments on a synchrotron beamline. Slow heating leads to a necklace austenite distribution whereas fast heating conducts to a banded topology. This particular microstructure morphogenesis is explained by the presence of numerous intergranular (or isolated) carbides inside the ferrite matrix, inherited from the hot-rolling. Thermokinetic analysis accounting for the cementite composition shows that the pearlite islands transformation necessarily involves the partition of substitutional elements. Conversely, the dissolving isolated carbides undergo a partition/partitionless transition on heating. After the dissolution of the cementite, a final ferrite/austenite transformation takes place. The phase transformation kinetics increases with increasing heating rates, despite the thermal-activated nature of the austenite growth process. This is interpreted thanks to kinetic simulations with DICTRA software, which allow to analyze the austenite growth regimes involving or not the partition of the alloying elements., Published by Elsevier Science, Amsterdam [u.a.]

International audience; The aim of this paper is to investigate the effective properties of Fe–TiB2 composites obtained after hot or cold rolling. The elastic moduli of both hot and cold rolled composites are measured experimentally using several methods. Microstructure analyses based on SEM observations are performed to characterize the distribution of particles and cracks, and are then used to generate 3D representative microstructures using the RSA method. This allows the numerical determination of the overall elastic behavior of Fe–TiB2 composites using full-field FFT-based simulations. In addition, Young’s moduli of the hot rolled Fe–TiB2 composites are also determined analytically using the mean-field homogenization scheme of Mori–Tanaka. The elastic properties determined experimentally, analytically and numerically are in a good agreement. Overall, a significant improvement of the specific stiffness in comparison to standard steels is achieved irrespective of the processing conditions

The evolution of the dislocation densities in martensite and in austenite during the quench of a low-carbon (0.215 wt% C) steel is investigated in situ by the mean of a High Energy X-Ray Diffraction experiment on a synchrotron beamline. The line configuration offers an excellent time resolution well adapted to the studied martensitic transformation kinetics. The mean density of dislocations in martensite increases as the transformation proceeds confirming that dislocations are not homogeneously distributed between the laths in agreement with some recent post-mortem observations. The resulting spatial distribution of dislocations and the associated strain-hardening support the views assuming that lath martensite is a heterogeneous microstructure and behaves as a “multiphase” aggregate. In austenite, the increase in dislocation densities is even more significant meaning that austenite in martensite is also a hard phase, contradicting some recent theories attributing to films of retained austenite a major role in the plasticity of martensite.

The disk diffusion test is very popular but for anaerobes the main pitfalls arise from the significant variation of diameters for an individual MIC and the weak correlation observed between the MIC's values and diameters zone that generates many major and very major errors. Aims of the study without any change in the methodology and revisiting only new diameter breakpoints, we try to improve the previous French recommendations and therefore decrease number of errors by introducing recent EUCAST concepts such as ECOFF and ATU Zone. Method MIC determination by agar dilution was done on 100 anaerobes against 6 antibiotics. Clinical categorization was based on EUCAST Breakpoints. Disk-diffusion method was realized on the same Brucella blood agar incubated in an anaerobic chamber. 550 categorizations by both methods could be done as amoxicillin was not tested on the 50 B. fragilis group. As anaerobic infections are severe and treated by antibiotics at higher dosage, we focus on resistance breakpoint to avoid mainly very major errors (VME). Distribution of inhibition zones for each MIC allow us to fix the zone diameter breakpoints. These results were matched to a large data on distribution of zone diameters for each antibiotic collected from two French hospitals from 1990 to 2005. As example for metronidazole and the B. fragilis group, we calculated the cut-off diameter (15 mm) from a wild type population, at a time when there was no resistance to this antibiotic and observed that it was identical to the diameter breakpoint for susceptibility. Results For an individual value of MIC, the distribution of diameters is wider for anaerobes especially for clindamycin and metronidazole. Using a 15 mm breakpoint for these two antibiotics limits dramatically the number of very major errors but slowly increases the number of major errors that could be overcome by MIC determination if inhibition zone is less than 15 mm. ATU zones (Area of technical uncertainty) were introduced for amoxicillin-clavulanate (17–20 mm), piperacillin-tazobactam (17–20 mm), imipenem (18–23 mm). Categorization inside the ATU requires MIC determination. Finally, out of 550 determinations, VME were observed in 1.45% of cases, an acceptable rate. Conclusion in combination with introduction of ATU zones disk diffusion method allows to detect resistant strains with little MIC determinations and very major errors.

In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study. Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania, and Ohio and in a national advocacy conference for patients with obesity. Participants were identified and recruited in both clinical and community settings. Focus group transcripts were analyzed using an iterative inductive-deductive approach to identify global overarching themes. There were 76 focus group participants. Participants were mostly women (81.4%), had primarily undergone gastric sleeve (47.0%), were non-Hispanic white (51.4%), had some college education (44.3%), and made $100,000 annual income or less (65.7%). Qualitative findings included negative reactions patients received from friends, family, and co-workers once they disclosed that they had bariatric surgery to lose weight; and barriers to follow-up care included insurance coverage, emotional and situational challenges, and physical pain limiting mobility. These findings confirm the other qualitative findings in this area. The approach to bariatric surgery should be expanded to provide long-term comprehensive care that includes in-depth postoperative lifetime monitoring of emotional and physical health.

International audience; An original mean field model for the nucleation and the growth of new recrystallized grains during annealing treatments of deformed, low-carbon ferritic steels is proposed in this paper. The model was calibrated on two steels extensively studied in the literature under both isothermal annealing and continuous heating schedules. It permits one to predict not only recrystallization kinetics but also advanced microstructural features (such as dislocation density, dislocation cell size and grain size) during complex heat treatments. Once calibrated, the model was applied to the case of a third ferrite/pearlite steel and was shown to accurately capture the effect of cold-rolling ratio on the recrystallization kinetics.

The growth kinetics of ferrite during intercritical annealing of steel has been investigated using in situ high energy X-ray diffraction with a specially designed furnace allowing highly quantitative measurements of phase volume fractions. Kinetics have been obtained at 730 ∘ C, 750 ∘ C and 775 ∘ C in different ternary Fe-C-X (where X : Mn, Ni, Mo and Cr) alloys and in a quaternary Fe-C-1Mn-1Cr (wt.%) alloy. The obtained results were compared with the predictions of classical Local Equilibrium and Para-Equilibrium models as well as an improved version of a three-jump solute drag model, where the interactions between the solute elements and the moving interface are described comprehensively. Good agreement was obtained between the measured ferrite growth kinetics and the predictions of the solute drag model for the different Fe-C-X systems using only one fitting parameter, namely the Fe-X interaction parameter at the interface. The interactions found here qualitatively match those reported in literature for all solutes except for Ni, which displayed an attractive interaction with the interface. For the quaternary Fe-C-Mn-Cr system, the solute drag model succeeded in predicting ferrite growth kinetics using the same interaction values as used for the ternary Fe-C-Mn and Fe-C-Cr systems.

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.

International audience; The thermo-mechanical properties of a ferritic-steel-based metal matrix composite reinforced with titanium diboride (TiB 2) particles were studied using synchrotron X-ray diffraction. The samples were subjected to in situ heat treatment to investigate the effect of the mismatch in the coefficient of thermal expansion between the matrix and reinforcement. In addition, in situ tensile tests were performed to examine the load partitioning in the composite. Load transfer from the ferritic matrix to the TiB 2 particles was observed at the onset of plasticity in the matrix.

Decisions about when to start or switch a therapy often depend on the frequency with which individuals are monitored or tested. For example, the optimal time to switch antiretroviral therapy depends on the frequency with which HIV-positive individuals have HIV RNA measured. This paper describes an approach to use observational data for the comparison of joint monitoring and treatment strategies and applies the method to a clinically relevant question in HIV research: when can monitoring frequency be decreased and when should individuals switch from a first-line treatment regimen to a new regimen? We outline the target trial that would compare the dynamic strategies of interest and then describe how to emulate it using data from HIV-positive individuals included in the HIV-CAUSAL Collaboration and the Centers for AIDS Research Network of Integrated Clinical Systems. When, as in our example, few individuals follow the dynamic strategies of interest over long periods of follow-up, we describe how to leverage an additional assumption: no direct effect of monitoring on the outcome of interest. We compare our results with and without the “no direct effect” assumption. We found little differences on survival and AIDS-free survival between strategies where monitoring frequency was decreased at a CD4 threshold of 350 cells/mu l compared with 500 cells/mu l and where treatment was switched at an HIV-RNA threshold of 1000 copies/ml compared with 200 copies/ml. The “no direct effect” assumption resulted in efficiency improvements for the risk difference estimates ranging from an 7- to 53-fold increase in the effective sample size.

Metals 9(1), 8 - (2019). doi:10.3390/met9010008, The annealing process of cold-rolled ferrite/pearlite steel involves numerous metallurgicalmechanisms as recovery/recrystallization of deformed phases, ripening of carbide microstructure,and austenite transformation in the intercritical domain. The interactions between these mechanismsgovern the morphogenesis of the transformed austenite microstructure and, thus, the final propertiesof the steel. This paper demonstrates that high energy X-ray diffraction (HEXRD) on synchrotronbeamline offers the unique possibility to follow concomitantly these mechanisms in situ duringa single experiment. A cold-rolled ferrite-pearlite steel dedicated to the industrial production ofDual-Phase steel serves as case-study. Synchrotron experiments have been conducted in transmissionat 100 keV with a 2D detector. Diffraction patterns acquired all along an annealing treatment are firstanalyzed after circular integration. A Rietveld refinement procedure coupled with a Williamson-Hallapproach is used to determine phase transformation and recovery kinetics. In this paper, a newmethod inspired by the 3D X-ray diffraction tomography is proposed to follow recrystallizationkinetics at the same time. It is based on a systematic detection of individual diffraction spots relatedto newly recrystallized grains appearing on Debye-Scherrer rings. The deduced recrystallizationkinetics is compared and validated by more conventional ex situ methods., Published by MDPI, Basel

A ferritic steel composite with titanium diboride (TiB2) particles produced by in-situ precipitation was studied by means of synchrotron X-ray diffraction. Samples were subjected to an in-situ heat treatment which allowed to study the mismatch in the coefficient of thermal expansion between the matrix and the reinforcement. In addition, in-situ tensile tests enable the observation of the load partitioning in the composite. A transfer of load from the ferritic matrix to the TiB2 particles was seen at the beginning of the plastic regimen of the matrix.

Objective: Due to the natural aging and the loosened CI-implantation criteria more formerly operated Meniere's patients will be supplied with a cochlear implant. However, it raises the question whether an implantation in a previously treated ear is promising. Material and Methods: Based on 2 cases in which we have carried out a CI-implantation, one of them 10 years after transmastoidal labyrinthectomy, and based on the current literature we draw attention to problems and prospects of success. Discussion: Histological studies show only a small ossification of the cochlea after labyrinthectomy. Implanted Meniere's patients have a better speech intelligibility than other CI users. Attacks of rotatory vertigo with tinnitus and fluctuations of hearing after cochlear implantation in Meniere's patients are rare or they are too little described. Conclusion: There is a trend to perform a simultaneous labyrinthectomy and cochlea implantation in Meniere's patients with desabling vertigo which have not responded to drug treatment. A formerly performed transmastoidal labyrinthectomy is not a contraindication for a cochlear implantation.

In-situ high energy X-Ray diffraction (HEXRD) was used on compositionally graded steels to study the effect of substitutional elements on ferrite growth kinetics in Fe&ndash, C&ndash, X and Fe&ndash, X&ndash, Y systems. Two systems were selected to illustrate the applicability of the combinatorial approach in studying such transformations, Fe&ndash, Mn and Fe&ndash, Mn&ndash, Mo. Comparison between the measured ferrite growth kinetics using HEXRD and the predicted ones using Para-Equilibrium (PE) and Local Equilibrium with Negligible Partitioning (LENP) models indicates that the fractions reached at the stasis of transformation are lower than the predicted ones. Experiments indicated a deviation of measured kinetics from both PE and LENP models when increasing Mn and decreasing Mo (in Fe&ndash, Mo system). The large amount of data that can be obtained using this approach can be used for validating existing models describing ferrite growth kinetics.

International audience; ObjectivesWe previously described extended-spectrum oxacillinase OXA-145 from Pseudomonas aeruginosa, which differs from narrow-spectrum OXA-35 by loss of Leu-155. The deletion results in loss of benzylpenicillin hydrolysis and acquisition of activity against ceftazidime. We report the crystal structure of OXA-145 and provide the basis of its switch in substrate specificity.MethodsOXA-145 variants were generated by site-directed mutagenesis and purified to homogeneity. The crystal structure of OXA-145 was determined and molecular dynamics simulations were performed. Kinetic parameters were investigated in the absence and in the presence of sodium hydrogen carbonate (NaHCO3) for representative substrates.ResultsThe structure of OXA-145 was obtained at a resolution of 2.3 Å and its superposition with that of OXA-10 showed that Trp-154 was shifted by 1.8 Å away from the catalytic Lys-70, which was not N-carboxylated. Addition of NaHCO3 significantly increased the catalytic efficiency against penicillins, but not against ceftazidime. The active-site cavity of OXA-145 was larger than that of OXA-10, which may favour the accommodation of large molecules such as ceftazidime. Molecular dynamics simulations of OXA-145 in complex with ceftazidime revealed two highly coordinated water molecules on the α- or β-face of the acyl ester bond, between Ser-67 and ceftazidime, which could be involved in the catalytic process.ConclusionsDeletion of Leu-155 resulted in inefficient positioning of Trp-154, leading to a non-carboxylated Lys-70 and thus to loss of hydrolysis of the penicillins. Ceftazidime hydrolysis could be attributed to enlargement of the active site and to a catalytic mechanism independent of the carboxylated Lys-70.

Steel-based composites reinforced with titanium diborides (TiB 2 ) and produced by eutectic solidification display a significant increase in specific stiffness ( E / ρ ) in comparison with usual steels. A significant lightening can be achieved in parts designed for stiffness with a high Young’s modulus and a low density. They can be produced through the use of industrial continuous casting devices and can be hot rolled without any damage. This production route guarantees a good cohesion of the steel/reinforcement interface and the control of the main parameters that determine the final properties of the product (size, shape, clustering of reinforcements). In order to get a better understanding of the composite properties, its microstructural features after hot rolling are investigated through transmission electron microscopy at microscopic and atomic levels. TiB 2 reinforcements are homogeneously distributed in the ferritic iron matrix. Interfaces between Fe and TiB 2 particles are mainly parallel to dense planes of the diboride, with a preferential growth of prismatic planes { 1 0 1 ¯ 0 } . Interfacial misfit dislocations occur at interfaces parallel to the prismatic planes. The TiB 2 basal plane is covered by a TiC layer three atomic planes in width. The hot rolling operation induces a significant plastic deformation in the TiB 2 particles, with the activation of basal and prism plane slip systems. All these characteristics may account for the good behaviour of the composite in terms of hot rolling capability.

Background Chromosomal class A β-lactamases have been characterized in Raoultella ornithinolytica and Raoultella planticola. The purpose of this study was to characterize that of Raoultella terrigena. Materials and methods The blaTER-1 gene of R. terrigena strain ATCC33257T was cloned (pACter-1) and sequenced. It was then used to detect the bla gene of strains BM 85 01 095 and SB2796. The hypermutable Escherichia coli strain AB1157 mutS::Tn10 was transformed with pACter-1 and mutants growing on plates containing > 2 mg/L ceftazidime were studied. Notably, the impact of mutations only observed in the promoter region on β-lactam resistance was assessed by site-directed mutagenesis experiments. Results R. terrigena strains ATCC33257T and BM 85 01 095 had the same bla gene and deduced protein (TER-1) whereas there were 3 substitutions in those of strain SB2796 (TER-2). Class A β-lactamases TER showed 78%, 69.9% and 38.7% identity with PLA or ORN, TEM-1 and KOXY, respectively. Compared with TEM-1, TER-1 and TER-2 showed 2 particular substitutions, Leu75Pro and Glu240Asn demonstrated to be involved in the inherent β-lactam resistance profile of R. terrigena. TER-1 (pI of 7.6) had a high activity against penicillin G and a significantly low one against amoxicillin. Substitution G/T observed in the -35 region of the blaTER gene harbored by strains growing in the presence of ≥ 2 mg/L ceftazidime was shown to be responsible for this growth. Conclusion TER is a new class A β-lactamase belonging to functional group 2b.

Cephalosporinases, which are naturally present in some enterobacterial species, can be mobilized by transposons, migrate to plasmids, and spread into other species such as Escherichia coli. The aim of this study was to characterize genes responsible for the production of extended-spectrum β-lactamases (ESBL) in E. coli isolates from urinary origin isolated in two hospitals in Senegal. Thus, a fortuitous discovery of plasmidic cephalosporinase in two isolates was noted. One of the isolates produced dha-1 associated with ESBL CTX-M-14, the other produced cmy-2, ESBL CTXM-15, tem-1 penicillinase, and oxa-1. This confirms the circulation of multidrug-resistant bacteria producing plasmidic cephalosporinase in Senegal. However, a large study is needed to better understand the prevalence and the nature of the genes involved.

Objectives To decrease the incidence of early-onset group B streptococcal (GBS) disease, a culture-based screening of all pregnant women at 35–37 weeks is recommended. This gold standard test requires 24–72 hours culture. This delay precludes its use for intrapartum screening. This study assesses a new immunoassay, the DIMA test, for identifying GBS-positive patients in the labor ward. Materials and methods This was a prospective observational study of 195 pregnant women presenting with full-term labor at a single site in France between June and August 2012. We assessed the diagnostic accuracy of intrapartum DIMA testing as compared to intrapartum GBS culture and prenatal screening at 35–38 weeks. Results The DIMA test sensitivity and specificity were 57.1% and 83.2%, respectively, as compared to 42.9% and 97% for prenatal culture screening. Conclusion The DIMA test assay is a rapid and inexpensive test for the detection of maternal GBS colonization in the labor ward. Its sensitivity is higher than antepartum culture but its specificity is lower. Its performance was inferior to that reported for rapid polymerase chain reaction assays.

Cephalosporinases, which are naturally present in some enterobacterial species, can be mobilized by transposons, migrate to plasmids, and spread into other species such as Escherichia coli. The aim of this study was to characterize genes responsible for the production of extended-spectrum β-lactamases (ESBL) in E. coli isolates from urinary origin isolated in two hospitals in Senegal. Thus, a fortuitous discovery of plasmidic cephalosporinase in two isolates was noted. One of the isolates produced dha-1 associated with ESBL CTX-M-14, the other produced cmy-2, ESBL CTXM-15, tem-1 penicillinase, and oxa-1. This confirms the circulation of multidrug-resistant bacteria producing plasmidic cephalosporinase in Senegal. However, a large study is needed to better understand the prevalence and the nature of the genes involved.

Background Clinical guidelines vary with respect to the optimal monitoring frequency of HIV-positive individuals. We compared dynamic monitoring strategies based on time-varying CD4 cell counts in virologically suppressed HIV-positive individuals. Methods In this observational study, we used data from prospective studies of HIV-positive individuals in Europe (France, Greece, the Netherlands, Spain, Switzerland, and the UK) and North and South America (Brazil, Canada, and the USA) in The HIV-CAUSAL Collaboration and The Centers for AIDS Research Network of Integrated Clinical Systems. We compared three monitoring strategies that differ in the threshold used to measure CD4 cell count and HIV RNA viral load every 3-6 months (when below the threshold) or every 9-12 months (when above the threshold). The strategies were defined by the threshold CD4 counts of 200 cells per mu L, 350 cells per mu L, and 500 cells per mu L. Using inverse probability weighting to adjust for baseline and time-varying confounders, we estimated hazard ratios (HRs) of death and of AIDS-defining illness or death, risk ratios of virological failure, and mean differences in CD4 cell count. Findings 47 635 individuals initiated an antiretroviral therapy regimen between Jan 1, 2000, and Jan 9, 2015, and met the eligibility criteria for inclusion in our study. During follow-up, CD4 cell count was measured on average every 4.0 months and viral load every 3.8 months. 464 individuals died (107 in threshold 200 strategy, 157 in threshold 350, and 200 in threshold 500) and 1091 had AIDS-defining illnesses or died (267 in threshold 200 strategy, 365 in threshold 350, and 459 in threshold 500). Compared with threshold 500, the mortality HR was 1.05 (95% CI 0.86-1.29) for threshold 200 and 1.02 (0.91.1.14) for threshold 350. Corresponding estimates for death or AIDS-defining illness were 1.08 (0.95-1.22) for threshold 200 and 1.03 (0.96-1.12) for threshold 350. Compared with threshold 500, the 24 month risk ratios of virological failure (viral load more than 200 copies per mL) were 2.01 (1.17-3.43) for threshold 200 and 1.24 (0.89-1.73) for threshold 350, and 24 month mean CD4 cell count differences were 0.4 (-25.5 to 26.3) cells per mu L for threshold 200 and -3.5 (-16.0 to 8.9) cells per mu L for threshold 350. Interpretation Decreasing monitoring to annually when CD4 count is higher than 200 cells per mu L compared with higher than 500 cells per mu L does not worsen the short-term clinical and immunological outcomes of virally suppressed HIV-positive individuals. However, more frequent virological monitoring might be necessary to reduce the risk of virological failure. Further follow-up studies are needed to establish the long-term safety of these strategies.

Neuroendokrine Neoplasien der Lunge leiten sich von diffus im Korper verteilten enterochromaffinen Zellen her. Die Inzidenz der neuroendokrinen Neoplasien der Lunge ist in den letzten Jahrzehnten aufgrund der zur Verfugung stehenden Diagnostik deutlich angestiegen, sie machen etwa 1 – 2 % aller Lungentumoren und ca. 20 – 30 % aller neuroendokrinen Neoplasien aus. Die aktuelle WHO-Klassifikation ist aus dem Jahre 2004 und unterteilt typische Karzinoide (TC), atypische Karzinoide (AC), groszellige Lungenkarzinome (LCNEC) und kleinzellige Lungenkarzinome (SCLC). Die wichtigsten neuroendokrinen Biomarker sind Chromogranin A, CD56 und Synaptophysin. TC haben eine geringe Mitoserate von Die steigende Zahl der therapeutischen Moglichkeiten und diagnostische Verfahren erfordert ein multidisziplinares Vorgehen und eine Entscheidungsfindung in multidisziplinaren Tumorkonferenzen, um eine „masgeschneiderte“ Therapie zu gewahrleisten, weshalb Patienten mit einer neuroendokrinen Neoplasie der Lunge in spezialisierten Zentren behandelt werden sollten.

Since the last decade, lightening of automotive structure was mainly achieved by gauge reduction using ultrahigh strength steels such as dual phase and transformation induced plasticity grades. However, gauge reduction can significantly reduce the stiffness. Limits are today reached for some applications such as chassis/suspension part. Development of steel with improved specific stiffness becomes more and more relevant to go further in weight reduction. Development of steel matrix composites (SMCs) with ceramic reinforcements is a promising solution. With an appropriate selection of the ceramic, eutectic solidification can be achieved. This natural production route guarantees a good cohesion of the steel/reinforcement interface and the control of the main parameters, which provide final properties of the product (size, shape, clustering of reinforcement). Significant fraction of ceramic can be obtained (10–25 vol.-%). Eutectic SMC can be produced with conventional industrial process such as conti...

Resume Introduction Le syndrome de Churg-Strauss est une vascularite systemique rare. Cette maladie est responsable d’un infiltrat eosinophile des tissus dont les manifestations les plus frequentes sont l’asthme cortico-dependant, une mono- ou multinevrite, une polypose des sinus de la face, des atteintes digestive et renale. L’atteinte des glandes salivaires est exceptionnelle. Observation Nous decrivons les caracteristiques d’une atteinte salivaire parotidienne bilaterale chez une patiente porteuse de ce syndrome. Le bilan morphologique detaille des glandes salivaires a mis en evidence un epaississement inhabituel des parois des canaux salivaires. Discussion Generalement au second plan du tableau clinique, et source d’errements diagnostiques, l’atteinte salivaire du syndrome de Churg et Strauss peut etre delicate a demontrer histologiquement. Il est recommande de realiser un prelevement tissulaire dans la glande responsable de la symptomatologie, en dehors de tout traitement corticoide.

Bei der hereditaren hamorrhagischen Teleangiektasie (HHT, Morbus Osler-Weber-Rendu) kann es zur Ausbildung von pulmonalen arteriovenosen Malformationen (pAVM) kommen. Zur Vermeidung von Komplikationen und zum Verschluss relevanter AV-Shunts sollte eine Embolisation der Malformationen vorgenommen werden. Im vorliegenden Fallbeispiel kam es zum Abhusten von Embolisationsspiralen 15 Jahre nach Intervention. Bei Hamoptysen nach Interventionen mit Embolisationsspiralen sollte auch Jahre nach deren Implantation neben dem Verdacht auf neue AV-Malformationen an durchwanderte Spiralen gedacht und eine entsprechende Diagnostik durch Einsatz von Thorax-CT mit Kontrastmittel und Bronchoskopie durchgefuhrt werden.

Anlasslich des 50. Geburtstags der Wissenschaftlichen Arbeitsgemeinschaft fur die Therapie von Lungenkrankheiten (WATL) wird ihre Geschichte von der Grundung bis zur heutigen Situation dargestellt. Es werden die Forschungsthemen der WATL uber diese lange Zeit hinweg benannt und wesentliche Studien der WATL kurz charakterisiert. Fruh vor allem mit Studien zur Tuberkulose beschaftigt, hat sich das Spektrum der WATL dann erheblich verbreitert und Krankheiten wie die Sarkoidose, die pulmonale Langerhans-Zell-Histiozytose, das Lungenemphysem beim α1-Antitrypsin-Mangel, die chronisch-obstruktive Bronchitis und das Asthma bronchiale sowie die nichttuberkulosen Mykobakteriosen ins Visier genommen. Schlieslich in der Erkenntnis, dass die methodischen Moglichkeiten fur grose Studien bei den klassischen Lungenkrankheiten unter aktuellen Anforderungen nicht ausreichen, hat die WATL begonnen, sich eine Kompetenz auf dem Sektor der seltenen Lungenkrankheiten wie Lymphangioleiomyomatose und Alveolarproteinose zu erwerben. Zusatzlich hat sich die WATL mit ihren nun zum dritten Mal durchgefuhrten Kongressen in Berlin ein edukatives Ziel im Bereich der nicht zum Mainstream gehorenden Fragen in der Pneumologie auf die Fahnen geschrieben.

Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of 18F-FDG-PET after neoadjuvant chemoradiation as a valid, non-invasive predictor for early therapy response and its effect on survival as compared to histopathologic tumor response, data of 32 of 210 randomized patients with NSCLC stage IIIA/IIIB, who were treated in a prospective randomized controlled multicenter trial (LUCAS- MD), were re-evaluated. Material and Methods: For 32 patients with NSCLC stage IIIA (44%) IIIB (56%) neoadjuvant treatment consisted of two to three cycles of chemotherapy (225 mg/m2 paclitaxel and carboplatin AUC 6 d1q22) and concomitant chemoradiation (50 mg/m2 paclitaxel and carboplatin AUC 2 d1, d8, d15; 1.5 Gy b.i.d. up to 45 Gy). Documentation of involved lymph node stations as detected by 18F-FDG-PET/CT and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with 18F-FDG-PET/CT for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests. Results: Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation plus chemotherapy: complete vs. incomplete metabolic remission prior to surgery after 60 months: 40% vs. 24% (p = 0.018). RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p = 0.006). 18/32 (56%) patients had RG III/IIb, 8/32 (25%) patients had regression grade III. 1/8 pts. with RG III were in the 18F-FDG- PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the 18F-FDG-PET/CT false negative. One patient with RG IIa was in the 18F-FDG-PET/CT false negative. Hence, the cut-off level in detecting vital tumor cells by 18F-FDG-PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Conclusion: Histological regression grading correlates well with metabolic remission as detected by 18F-FDG-PET. Thus, 18F-FDG-PET precedes CT in measuring the tumor response and may predict long-term therapeutic outcome in patients with stage III NSCLC. Invasive staging procedures may be avoided and patients who will not profit from resection due to insufficient downstaging after neoadjuvant treatment will be easily detected by using 18F-FDG-PET as standard imaging in workup and evaluation of treatment response.