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Cadmium-zinc-telluride (CZT) SPECT/CT cameras with large field of view offer a higher sensitivity than conventional Anger cameras. This prospective study aimed to determine the equivalence between a conventional protocol and a reduced acquisition time protocol for 201-Thallium myocardial perfusion imaging (MPI) using a whole-body CZT SPECT camera. Stress MPI was obtained for 103 consecutive patients on a DISCOVERY-CZT camera. Images were anonymized and post-processed to simulate a 25% (D75 dataset) and 50% (D50 dataset) decrease in total recorded counts. Concerning the number of segments displaying a tracer uptake

International audience; ObjectivesWe aimed to investigate the first Omicron cases detected in France in order to assess case characteristics and provide supporting information on the possible impact of this variant on the healthcare system.MethodsA standardized questionnaire was used to collect information from confirmed and probable Omicron cases.ResultsMedian age of 468 investigated cases was 35 years, 376 were symptomatic (89%); 64% were vaccinated with two doses and 7% had received three doses. Loss of smell and taste were reported by 8.3% and 9% of cases, respectively. Seven cases were hospitalized, three of those were unvaccinated (including two with reported precondition). No admissions to intensive care and no deaths were reported.ConclusionsOur results confirm a mild clinical presentation among the first Omicron cases detected in France and highlight the importance for the national COVID-19 surveillance system to quickly detect and adapt to the emergence of a new variant.

The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity.Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal ischemic injury using multivariate regression analysis. We also compared the outcomes (organ failure during ICU stay and neurological status at hospital discharge) of the three groups of patients.Among the 214 patients included in the analysis, 121 (57%, 95% CI 50-63%) had an upper gastrointestinal ischemic lesion, most frequently on the fundus. Ischemic lesions were severe in 55/121 (45%) patients. In multivariate regression, higher adrenaline dose during cardiopulmonary resuscitation (OR 1.25 per mg (1.08-1.46)) was independently associated with increased odds of severe upper gastrointestinal ischemic lesions; previous proton pump inhibitor use (OR 0.40 (0.14-1.00)) and serum bicarbonate on day 1 (OR 0.89 (0.81-0.97)) were associated with lower odds of ischemic lesions. Patients with severe lesions had a higher SOFA score during the ICU stay and worse neurological outcome at hospital discharge.More than half of the patients successfully resuscitated from OHCA had upper gastrointestinal tract ischemic injury. Presence of ischemic lesions was independently associated with the amount of adrenaline used during resuscitation. Patients with severe lesions had higher organ failure scores during the ICU stay and a worse prognosis. Clinical Trial Registration NCT02349074 .

Background Successful 2-drug regimens (2DRs) for HIV were made possible by the availability of drugs combining potency and tolerability with a high genetic barrier to resistance. How these deal with resistance development/re-emergence, compared with 3DRs, is thus of paramount importance. Materials and methods A national survey including patients who were either naive or experienced with any 2DR or 3DR but failing integrase strand transfer inhibitor (INSTI)-containing regimens [two consecutive plasma viral load (VL) values >50 copies/mL] was conducted between 2014 and 2019. Genotypic resistance tests were interpreted with the v28 ANRS algorithm. Results Overall, 1104 patients failing any INSTI-containing regimen (2DRs, n = 207; 3DRs, n = 897) were analysed. Five hundred and seventy-seven (52.3%) patients were infected with a B subtype and 527 (47.3%) with non-B subtypes. Overall, 644 (58%) patients showed no known integrase resistance mutations at failure. In multivariate analysis, factors associated with the emergence of at least one integrase mutation were: high VL at failure (OR = 1.24 per 1 log10 copies/mL increase); non-B versus B subtype (OR = 1.75); low genotypic sensitivity score (GSS) (OR = 0.10 for GSS = 2 versus GSS = 0–0.5); and dolutegravir versus raltegravir (OR = 0.46). Although 3DRs versus 2DRs reached statistical significance in univariate analysis (OR = 0.59, P = 0.007), the variable is not retained in the final model. Conclusions This study is one of the largest studies characterizing integrase resistance in patients failing any INSTI-containing 2DR or 3DR in routine clinical care and reveals factors associated with emergence of integrase resistance that should be taken into consideration in clinical management. No difference was evidenced between patients receiving a 2DR or a 3DR.

Cadmium-zinc-telluride (CZT) SPECT/CT cameras with large field of view offer a higher sensitivity than conventional Anger cameras. This prospective study aimed to determine the equivalence between a conventional protocol and a reduced acquisition time protocol for 201-Thallium myocardial perfusion imaging (MPI) using a whole-body CZT SPECT camera.Stress MPI was obtained for 103 consecutive patients on a DISCOVERY-CZT camera. Images were anonymized and post-processed to simulate a 25% (D75 dataset) and 50% (D50 dataset) decrease in total recorded counts. Concerning the number of segments displaying a tracer uptake 70% of maximum intensity per patient, equivalence was demonstrated for both count-reduced datasets with a good inter-observer agreement (between 0.90 and 0.88). When comparing the full-vs-D75 datasets and full-vs-D50 datasets, mean difference was 0.06 segment (CI95: [- 0.15;0.27], P 0.001) and 0.518 segment (CI95: [0.28;0.76], P 0.001) respectively. Inter-observer agreement was also moderate to good concerning the number of pathological segments (between 0.6 and 0.7) and excellent for functional parameters.Whole-body CZT SPECT/CT cameras allow to reduce 201-Thallium MPI injected activity or acquisition time by 50% with an equivalence in the number of segments displaying a tracer uptake 70% of maximum intensity and with a good inter-observer agreement.

Introduction La sclerodermie systemique (ScS) est une maladie auto-immune rare, heterogene et chronique. Les pneumopathies interstitielles diffuses (PID) caracterisees par un declin progressif de la fonction respiratoire constituent une complication frequente de la ScS et sa principale cause de deces. En Europe, la prevalence de la PID-ScS a ete estimee a 1,7–4,2/100 000 individus et l’incidence annuelle a 0,1–0,4/100 000 individus. En France, l’epidemiologie de cette maladie est encore meconnue. Ainsi, les objectifs de cette etude etaient d’estimer la prevalence et l’incidence de la PID-ScS en France et de decrire les caracteristiques et la survie des patients. Methodes Une cohorte retrospective longitudinale a ete constituee a partir des donnees du Systeme national des donnees de sante entre 2010 et 2017. Les patients ont ete identifies comme etant atteints d’une PID-ScS grâce a un algorithme base sur l’utilisation de codes CIM-10. Ainsi, tous les patients de plus de 20 ans, affilies au regime general d’Assurance Maladie depuis plus de deux ans, et avec: – au moins une hospitalisation ou une affection de longue duree relative a une ScS; – au moins une hospitalisation avec un code de fibrose pulmonaire ont ete inclus. Resultats Parmi les patients identifies avec une ScS, 34 % presentaient une PID, soit 3333 patients. Les trois quarts etaient des femmes (75,6 %). La moyenne (ecart-type) d’âge etait de 60,6 (± 14,4) ans. Les principales comorbidites etaient l’hypertension (66,8 %) et le reflux gastro-œsophagien (65,8%). L’incidence globale estimee etait de 0,98–0,76/100 000 individus et la prevalence de 3,42–5,52/100 000 individus sur l’ensemble de la periode. Les taux de prevalence et d’incidence etaient trois fois plus eleves chez les femmes que chez les hommes et augmentaient avec l’âge. Les estimations de la survie globale etaient de 93 % a 1 an, 82% a 3 ans, 71 % a 5 ans et 55% a 8 ans. Les facteurs associes a la mortalite etaient le sexe masculin, la presence d’une hypertension pulmonaire, la presence d’un cancer du poumon et les classes d’âges les plus elevees. Conclusion Cette etude presente pour la premiere fois au niveau national l’epidemiologie de la PID-ScS. Notamment, elle a permis de montrer que la PID-ScS presente un taux de mortalite eleve, en particulier chez les patients a risque.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus inflammatoire diffus. Chez certains patients atteints de PID, un phenotype fibrosant progressif (FP) se developpe, comparable a celui observe dans la fibrose pulmonaire idiopathique (FPI). L’objectif de l’etude etait de fournir les caracteristiques des patients et les estimations d’incidence, de prevalence et de mortalite de la PID-FP (hors fibrose pulmonaire idiopathique) a l’echelle nationale en vie reelle. Methodes Une cohorte retrospective longitudinale de patients atteints de PID-FP a ete constituee a partir des donnees du Systeme National des Donnees de Sante (SNDS). Les patients PID-FP ont ete selectionnes selon un algorithme d’identification base sur l’utilisation de codes CIM-10 en trois etapes successives: identification des PID, exclusion des FPI, et selection des FP. Resultats 30 771 patients atteints de PID hors FPI ont ete identifies. Parmi eux, 14 413 patients (47 %) susceptibles de presenter une forme progressive ont ete inclus. Un peu plus de la moitie des patients etaient des hommes (52 %). L’âge moyen (ecart-type) etait de 68,4 ans (± 15,0). Les comorbidites les plus frequentes etaient l’hypertension (64 %) et le reflux gastro-œsophagien (55 %). La prevalence des patients avec un phenotype progressif variait de 6,6 a 19,4/100 000 individus selon l’annee et l’incidence annuelle de 3,1 a 4,7/100 000 individus. Les taux de prevalence et d’incidence etaient legerement plus faibles chez les femmes que chez les hommes, et augmentaient considerablement avec l’âge. La mediane de la survie globale a ete estimee a 3,7 ans [3,6–3,8]. Le taux de survie etait de 74 % a 1 an, 55 % a 3 ans, 42 % a 5 ans et 32 % a 8 ans. Les facteurs associes a la mortalite etaient le sexe masculin, l’âge et l’etiologie de la PID-FP. Conclusion Dans cette etude, 47 % des patients atteints de PID etaient susceptibles de presenter une forme progressive comparativement a environ 30 % dans la litterature. Cette difference pourrait s’expliquer par l’utilisation pour la selection des patients avec FP, d’un algorithme base sur l’utilisation de consommations de soin, sans possibilite de validation diagnostique des formes progressives. En conclusion, cette etude qui est la premiere a estimer l’epidemiologie des PID-FP en France grâce a l’utilisation du SNDS, suggere que les PID-FP representent au total un assez grand nombre de patients, et sont associees a un mauvais pronostic.

Resume Introduction La torsion externe de la tuberosite tibiale anterieure (TTA), definie par une rotation externe selon un axe cranio-caudal par rapport au plan bi-condylien femoral posterieur, est potentiellement un facteur d’instabilite patellaire. Aucune etude n’a, a notre connaissance, ete publiee sur cette mesure. Ce travail avait pour objet une etude IRM de la torsion de la TTA. L’hypothese etait qu’elle etait correlee a l’instabilite patellaire et a trois de ses parametres : la distance tuberosite tibiale anterieure — Gorge Trochleenne (TA-GT), l’index d’engagement patellaire axial (IEA) et la bascule patellaire. Materiel et methodes Quatre observateurs ont fait les mesures sur les IRM de deux groupes : un groupe « Instabilite patellaire (IP) » de 37 patients ayant presente au moins deux luxations patellaires, un groupe « Temoin » de 55 patients porteurs d’une lesion meniscale et exempts de pathologie femoro-patellaire. Toutes les mesures ont ete effectuees sur deux coupes axiales avec pour reference le plan bi-condylien posterieur. Resultats Le coefficient de concordance intra-classes (ICC) etait de 0,88. La torsion de la TTA etait correlee a l’instabilite patellaire, avec une valeur moyenne de 5,8° pour le groupe « Temoin » et de 17,9° pour le groupe « IP » (p Discussion La mesure de la torsion de la TTA est reproductible avec une excellente concordance inter-observateur. Elle est statistiquement liee a l’instabilite patellaire, avec un seuil de discrimination de 11,5°. Elle est correlee aux trois parametres de l’instabilite. Ces liens statistiques permettent d’ajouter la torsion de la TTA a la liste des facteurs d’instabilite patellaire. Des etudes ulterieures sont souhaitables pour determiner son role biomecanique et evaluer l’utilite d’un eventuel geste associe de derotation de la TTA lors d’une medialisation ou abaissement de la TTA. Niveau de preuve Niveau 3. Etude cas-temoins.

External torsion of the anterior tibial tubercle (TT), defined as external rotation around a craniocaudal axis with respect to the posterior femoral condylar plane, may induce patellar instability. To our knowledge no studies have focused on this parameter. The present study aimed to perform an MRI analysis of TT torsion. The study hypothesis was that TT torsion correlates with patellar instability and with 3 of its components: tibial tubercle-trochlear groove (TT-TG) distance, axial engagement index of the patella (AEI), and patellar tilt.Four observers performed MRI measurements for 2 groups: 37 patellar instability patients (PI group) with history of at least 2 patellar dislocations, and 50 control patients with meniscal lesion but free from patellofemoral pathology. All measurements were taken from 2 axial slices with the posterior condylar plane as reference.The intra-class correlation coefficient (ICC) was 0.88. TT torsion correlated with patellar instability, with a mean 5.8̊ in controls and 17.9̊ in the PI group (P0.001). There were also excellent correlations between TT torsion and TT-TG distance, patellar tilt and patellar lateralization (measured by AEI), with correlation coefficients greater than 0.85.TT torsion is a reproducible measurement, with excellent ICC. It is significantly correlated with patellar instability, with a discrimination threshold of 11.5̊, and correlations with all 3 components of instability. These statistical correlations enable TT torsion to be added to the list of patellar instability factors. Further studies should determine its biomechanical role and assess the contribution of associating TT derotation to medialization or distalization procedures.III; case-control study.

Objectifs Cette etude de cohorte retrospective et monocentrique visait a evaluer les caracteristiques cliniques, l’evolution de la fonction pulmonaire et la survie globale des patients atteints d’une PID-FP autre que FPI en vie reelle. Methodes Tous les patients hospitalises dans un centre de reference des maladies pulmonaires rares entre 2010 et 2017, âges de 18 ans ou plus, presentant une fibrose pulmonaire d’au moins 10 % ont ete preselectionnes. Les patients presentant une PID-FP selon les criteres suivants ont ete inclus : – baisse relative de la capacite vitale forcee (CVF) ≥ 10 % avec ou sans deterioration clinique ; – ou baisse relative de la CVF entre 5 % et 10 % associee a une aggravation des symptomes respiratoires ou a une augmentation de l’etendue de la fibrose ; – ou augmentation de l’etendue de la fibrose avec aggravation des symptomes respiratoires avec ou sans diminution de la CVF. Un appariement probabiliste a ete realise afin de chainer les patients de cette cohorte au Systeme national des donnees de sante (SNDS) afin d’extraire les consommations de soins et de les valoriser. Resultats Au total, 165 patients (dont 57 % de femmes) ont ete inclus avec un âge moyen de 60 ans (± 14 ans). La plupart des patients (65 %) ont ete inclus avec le critere (a), 24 % avec le critere (b) et 9 % avec le critere (c). Les estimations de la survie globale etaient respectivement de 99 %, 82 % et 66 % a 1, 3 et 6 ans. La mortalite etait associee de maniere significative a une CVF Conclusion Cette cohorte est la premiere decrivant l’histoire naturelle de toutes les PID-FP autres que la FPI. Le chainage des donnees de la cohorte a celles du SNDS a permis d’obtenir une grande quantite d’informations visant a mieux caracteriser la prise en charge et l’evolution de ces maladies. L’histoire naturelle des PID-FP suit un schema caracterise par une aggravation des symptomes respiratoires, un declin progressif de la fonction pulmonaire et une mortalite precoce malgre une prise en charge appropriee.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus inflammatoire, diffus, et parfois fibrosant (PID) [1] . Certains patients atteints de PID fibrosante, peuvent developper un phenotype d’evolution progressive comparable a celui observe dans la fibrose pulmonaire idiopathique ; ces pathologies sont regroupees sous le terme de PID de phenotype ou de forme progressive (PID-FP) [2] . L’objectif est de decrire la frequence, les caracteristiques cliniques et l’evolution des patients PID-FP hors FPI. Methodes L’etude a porte sur tous les patients successifs hospitalises dans un centre de reference des maladies pulmonaires rares entre janvier 2010 et decembre 2017, âges de 18 ans et plus, et presentant une PID fibrosante diagnostiquee par scanner thoracique. Parmi eux, les patients presentant une PID-FP ont ete selectionnes sur les criteres de progression definis par une baisse de la CVF ≥ 10 % avec ou sans deterioration clinique, ou une baisse de la CVF entre 5 et 10 % associee a une aggravation des symptomes respiratoires, ou une baisse de la CVF entre 5 et 10 % associee a une etendue croissante de la fibrose au scanner en moins de 24 mois. Cette etude a ete approuvee par la CNIL le 09/2018 (918305). Resultats Actuellement 149 patients presentant une PID-FP ont ete inclus. La majorite des patients etaient des femmes (57 %) d’âge moyen 59 ± 14 ans. La CVF moyenne etait de 73,3 ± 21 % de la theorique et la DLco de 43,0 ± 17,5 %. Pour les 104 patients dont l’information est disponible, la duree entre le diagnostic de la PID et celui de la progression etait de 2,7 ± 3,8 ans. La repartition etiologique etait : 8 % de pneumopathie d’hypersensibilite, 6 % de pneumopathie interstitielle non specifique idiopathique, 24 % de PID inclassable, 48 % de PID auto-immune, et 14 % d’autres PID. Les criteres de progression etaient une baisse de la CVF ≥ 10 % (65 %), une baisse de la CVF de 5–10 % associee a une aggravation des symptomes (24 %), une baisse de la CVF de 5–10 % associee a une etendue croissante de la fibrose au scanner (2 %) ou une aggravation des symptomes et une etendue croissante de la fibrose au scanner (9 %) en moins de 24 mois. Conclusion Ces resultats preliminaires fournissent des elements sur l’epidemiologie des patients PID-FP pour lesquels un essai therapeutique avec le nintedanib est actuellement en cours.

Introduction La sclerodermie systemique (ScS) est une maladie auto-immune rare, heterogene, et chronique. Les pneumopathies interstitielles diffuses (PID) caracterisees par un declin progressif de la fonction respiratoire constituent une complication frequente de la ScS et sa principale cause de deces. En Europe, la prevalence de la PID-ScS a ete estimee a 1,7–4,2/100 000 individus et l’incidence annuelle a 0,1–0,4/100 000 individus. En France, l’epidemiologie de cette maladie est encore meconnue. Ainsi, les objectifs de cette etude etaient d’estimer la prevalence, l’incidence de la PID-ScS en France et de decrire les caracteristiques et la survie des patients. Patients et methodes Une cohorte retrospective longitudinale a ete constituee a partir des donnees du Systeme National des Donnees de Sante entre 2010 et 2017. Les patients ont ete identifies comme etant atteints d’une PID-ScS grâce a un algorithme base sur l’utilisation de codes CIM-10. Ainsi, tous les patients de plus de 20 ans, affilies au regime general d’Assurance Maladie depuis plus de deux ans, et avec : – au moins une hospitalisation ou une affection de longue duree relative a une ScS ; – au moins une hospitalisation avec un code de fibrose pulmonaire ont ete inclus. Resultats Parmi les patients identifies avec une ScS, 34 % presentaient une PID, soit 3 333 patients. Les trois quarts etaient des femmes. La moyenne (ecart-type) d’âge etait de 60,6 (± 14,4) ans. L’incidence globale estimee etait de 0,98–0,76/100 000 individus et la prevalence de 3,42–5,52/100 000 individus sur l’ensemble de la periode. Les taux de prevalence et d’incidence etaient environ trois fois plus eleves chez les femmes que chez les hommes et augmentaient considerablement avec l’âge. Les estimations de la survie globale etaient de 93 % a 1 an, 82 % a 3 ans, 71 % a 5 ans et 55 % a 8 ans. Les facteurs associes a la mortalite etaient le sexe masculin, la presence d’une hypertension pulmonaire, la presence d’un cancer du poumon et les classes d’âges les plus elevees. Discussion La principale limite de l’etude pouvant impacter l’incidence et la prevalence repose sur les modalites de selection des patients et le risque de non-inclusion des patients n’ayant pas ete hospitalises. Neanmoins, les resultats sont coherents avec les donnees de la litterature. Conclusion Cette etude presente pour la premiere fois au niveau national l’epidemiologie de la PID-ScS. Notamment, elle a permis de montrer que la PID-ScS presente un taux de mortalite eleve, en particulier chez les patients a risque.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus diffus inflammatoire et/ou fibrosant. Certains patients atteints de PID fibrosante peuvent developper un phenotype a evolution progressive (PID-FP) similaire a celui observe dans la fibrose pulmonaire idiopathique (FPI). L’objectif de cette etude est de developper des algorithmes pour identifier les patients avec PID-FP au sein du Systeme national des donnees de sante (SNDS) afin de mieux connaitre l’epidemiologie et le fardeau de ces maladies en France. Methodes Un premier algorithme base sur des travaux americains existants et l’expertise de cliniciens a ete developpe. Il consiste a identifier, a travers le Programme de medicalisation des systemes d’informations (PMSI) et les affections de longue duree (ALD), les patients atteints d’une PID. Apres exclusion des FPI, les formes progressives sont selectionnees a partir des donnees de demandes de remboursement pour des traitements specifiques, de consultations chez le pneumologue, d’actes d’imagerie, d’examens de la fonction pulmonaire et/ou d’hospitalisations. Une seconde approche consistera a creer un algorithme via une approche par apprentissage automatique grâce au recoupement des donnees du SNDS et d’une cohorte clinique suivie par le Centre national de reference des maladies pulmonaires rares de Lyon. Resultats Le premier algorithme a ete developpe et est actuellement applique sur les donnees du SNDS afin de detecter les cas prevalents et incidents de PID-FP non-FPI entre 2010 et 2017. L’ensemble des resultats de l’etude est attendu pour la fin de l’annee 2019 et les resultats finaux seront presentes au congres. Discussion/Conclusion Le developpement de ces deux algorithmes par des approches differentes permettra de comparer les resultats obtenus et de choisir l’approche la plus valide pour approfondir les connaissances sur ces pathologies. Cette etude permettra d’estimer le nombre de patients atteints de PID-FP non-FPI, de decrire leur parcours de soins et les couts associes, ainsi que d’explorer les facteurs associes a leur morbi-mortalite.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus diffus inflammatoire et/ou fibrosant [1] . Certains patients atteints de PID fibrosante, peuvent developper un phenotype a evolution progressive similaire a celui observe dans la fibrose pulmonaire idiopathique (FPI), ces pathologies etant regroupees sous le terme de PID a forme progressive (PID-FP) [2] . L’objectif de cette etude est de developper des algorithmes pour identifier les patients avec PID-FP non-FPI afin de decrire l’epidemiologie, et le fardeau global de ces maladies en France. Methodes Un algorithme base sur la CIM-10, et reposant sur des algorithmes americains, a ete developpe en France afin de selectionner entre le 01/01/2010 et le 31/12/2017 les cas prevalents et incidents de PID-FP non-FPI au sein du Systeme national des donnees de sante (SNDS). Un algorithme sera aussi developpe a partir de la cohorte clinique de patients avec PID-FP non-FPI suivis par le Centre national de reference des maladies pulmonaires rares de Lyon. Resultats Un premier algorithme a ete developpe pour extraire les sejours des patients atteints de PID-FP, base sur la selection de l’ensemble des sejours avec un code de diagnostic de fibrose pulmonaire puis l’exclusion des patients FPI. Les formes progressives seront enfin extraites a partir des donnees de demandes de remboursement pour des traitements specifiques, de consultations chez le pneumologue, d’actes d’imagerie, d’examens de la fonction pulmonaire et/ou d’hospitalisations. La seconde approche consistera a creer un algorithme via une approche par apprentissage automatique grâce au recoupement des donnees du SNDS et de la cohorte clinique. Conclusion Le developpement de ces deux algorithmes par des approches differentes permettra de comparer les resultats obtenus et de choisir l’approche la plus valide pour approfondir les connaissances sur ces pathologies. Cette etude permettra d’estimer le nombre de patients atteints de PID-FP non-FPI, de decrire leur parcours de soins et les couts associes, ainsi que d’explorer la correlation entre la capacite vitale forcee de ces patients et leur morbi-mortalite.

Introduction Les pneumopathies interstitielles diffuses (PID) regroupent un ensemble heterogene de maladies caracterisees par un processus diffus inflammatoire et/ou fibrosant [1] . Certains patients atteints de pneumopathie interstitielle diffuse fibrosante, peuvent developper un phenotype a evolution progressive similaire a celui observe dans la fibrose pulmonaire idiopathique (FPI), ces pathologies etant regroupees sous le terme de pneumopathie interstitielle diffuse a forme progressive (PID-FP) [2] . L’objectif de cette etude est de developper des algorithmes pour identifier les patients avec PID-FP non-FPI afin de decrire l’epidemiologie, et le fardeau global de ces maladies en France. Methodes Un algorithme bases sur la CIM-10, et reposant sur des algorithmes americains, a ete developpe en France afin de selectionner entre le 01/01/2010 et le 31/12/2017 les cas prevalents et incidents de PID-FP non-FPI au sein du Systeme national des donnees de sante (SNDS). Un algorithme sera aussi developpe a partir de la cohorte clinique de patients avec PID-FP non-FPI suivis par le Centre national de reference des maladies pulmonaires rares de Lyon. Description des algorithmes Un premier algorithme a ete developpe pour extraire les sejours des patients atteints de PID-FP, base sur la selection de l’ensemble des sejours avec un code de diagnostic de fibrose pulmonaire puis l’exclusion des patients FPI. Les formes progressives seront enfin extraites a partir des donnees de demandes de remboursement pour des traitements specifiques, de consultations chez le pneumologue, d’actes d’imagerie, d’examens de la fonction pulmonaire et/ou d’hospitalisations. La seconde approche consistera a creer un algorithme via une approche par apprentissage automatique grâce au recoupement des donnees du SNDS et de la cohorte clinique. Conclusion Le developpement de ces deux algorithmes par des approches differentes permettra de comparer les resultats obtenus et de choisir l’approche la plus valide pour approfondir les connaissances sur ces pathologies. Cette etude permettra d’estimer le nombre de patients atteints de PID-FP non-FPI, de decrire leur parcours de soins et les couts associes, ainsi que d’explorer la correlation entre la capacite vitale forcee de ces patients et leur morbi-mortalite.

Varicella-zoster virus (VZV) is, like other alphaherpes viruses, neurotropic. Of the admissions to hospital for varicella, 7.6-25% are due to neurologic manifestations. Most of the time, the concomitant skin lesions facilitate the diagnosis. The justification of qualitative PCR (polymerase chain reaction) for VZV DNA in cerebrospinal fluid in the management of these patients is not clear. The aim of this study was to evaluate the prognostic value of qualitative PCR for VZV DNA in cerebrospinal fluid and to assess its impact on patient management. We conducted a retrospective monocentric study in Versailles Hospital (France). It included every child admitted for neurologic manifestations associated with varicella and compared the patients with positive PCR for VZV DNA to those with a negative PCR in the cerebrospinal fluid. Seven patients with positive PCR and 16 patients with negative PCR were included. The median age of the children included was 3 years (range, 1.6-12 years) and 2 years (range, 0.6-5 years), respectively. In the positive PCR group, 86% of the children had fever on first examination and the average time between the onset of skin lesions and neurological signs was +1.28 days (range, -2 to +5 days). In comparison, in the negative PCR group, 81% of the children had fever and the average time delay was +1.75 days (-2 to +7 days). There was no significant difference in terms of length of hospitalization; 3 days (range, 0-6 days) and 3 days (range, 2-7 days), respectively. All patients discharged from our department went home. In addition, there was no significant difference between the two groups in terms of treatment with acyclovir; two children (28.5%) were treated in the positive PCR group versus four (25%) in the negative PCR group. Our study showed no prognostic value for qualitative PCR for VZV DNA in the cerebrospinal fluid of patients with neurologic manifestations of varicella. Therefore, its relevance can be questioned in clinical practice. However, in case of encephalitis and meningitis during primary infection with VZV, quantitative PCR for VZV DNA might have a prognostic value and therefore requires further study.

Irritable bowel syndrome is a chronic functional gastrointestinal disorder characterized by abdominal pain/discomfort and altered bowel habits. The use of Lactobacilli as probiotics during irritable bowel syndrome is based on their interesting mechanisms of action and their excellent safety profile but little is known about their clinical efficacy due to the lack of adequately designed clinical trials. The current clinical trial protocol aims to determine the effects of a mixture of Lactobacillus acidophilus NCFM and LAFTI L10 as probiotics to improve irritable bowel syndrome symptoms (LAPIBSS). Eighty patients with a positive diagnosis of irritable bowel syndrome according to Rome III criteria were recruited to a multicentre, double-blinded, in parallel groups, placebo-controlled randomized trial. Patients were provided with a daily dose of two capsules with two strains of Lactobacilli (5x109cfu/capsule) or placebo for 8 weeks on a 1:1 ratio. The primary outcome is to obtain scores of abdominal pain/discomfort assessed with a 100-mm visual analogue scale. The secondary outcome is to obtain scores of bloating, flatus and rumbling tested with a 100-mm visual analogue scale, composite score, stool frequency and stool consistency/appearance assessed with the Bristol Stool Form scale. According to the hypothesis that abdominal pain is mainly the result of a visceral hypersensitivity, the current study protocol aims to provide high quality proof of concept data to elucidate the efficacy of a consumption of a mixture of Lactobacillus acidophilus probiotic strains after 8 weeks, for decreasing abdominal pain. Ethical approval was given by ethics committee French Consultative Committee for the Protection of Individuals in Biomedical Research of the South West (Number CPP08-014a) and ANSM (French National Agency for Medicines and Health Products Safety – Number B80623-40). The findings from LAPBISS will be disseminated through peer-reviewed publications and at scientific conferences. Trial registration: EudraCT N°2008-A00844-51

Enteroviruses (EV) are a common cause of aseptic meningitis in children. Virological diagnosis of EV meningitis is currently based on the detection of the viral genome in the cerebrospinal fluid (CSF). This study attempted to determine the correlation and the temporality of the polymerase chain reaction (PCR) assay in serum and CSF and to evaluate the possibility of diagnosing EV infection only on the serum PCR. The EV genome was sought by RT real-time PCR (Smart Cycler EV Primer and Probe Set(®), Cepheid) in CSF and serum, collected at the same time, for all children who underwent a lumbar puncture for suspected meningitis, between 1 June and 31 July 2010 at the Versailles Hospital. Forty-four patients were included in the study. EV infection was documented for 22 of them. In 10 patients, the EV genome was detected in CSF only; in 3 patients in serum only, and in 9 patients in both. Among patients with acute EV neurological infection, viremic children were significantly younger (1.6 months versus 5.8 years; P 3 months, clinical and biological compatibility with a viral infection, no previous antibiotic therapy, time from symptom onset to blood sampling

Resume Introduction Lors de la prise en charge de patients suspectes d’intoxication, les medecins doivent rapidement poser un diagnostic. A ce jour en France, il n’existe pas de donnees exhaustives sur les toxiques les plus souvent impliques. Materiel et methodes Cette etude retrospective porte sur les substances annoncees a l’admission de patients hospitalises pour intoxication aigue en 2011, dans le service de reanimation medicale et toxicologique du groupe hospitalier Lariboisiere-Fernand-Widal-Saint-Louis. Les substances annoncees ont ete recueillies dans la transcription de l’anamnese d’admission qui figure dans le dossier medical des patients. Les verbatims ont ete harmonises et les substances regroupees en substances medicamenteuses et en trois categories de substances non medicamenteuses (recreatives et/ou addictives, autres, de nature inconnue). Resultats Trois cent quinze patients ont ete admis, avec 891 occurrences de substances nominativement annoncees dont 198 differentes. La majorite des substances (83 %) sont des medicaments, agissant pour la plupart sur le systeme nerveux ou le systeme cardiovasculaire, mais nous retrouvons egalement des substances non medicamenteuses de type recreatif/addictif (12 %) ou autres (3 %). Parmi les occurrences, 1,5 % correspondent a des substances inconnues. Discussion Les substances supposement impliquees dans les intoxications devraient faire l’objet d’enseignement de toxicologie et de dosage en routine par les laboratoires de toxicologie analytique. Conclusion La perennisation d’une telle analyse au cours des annees constituera un observatoire des substances impliquees dans les intoxications aigues.

Resume Les parechovirus (HPeV), comme les enterovirus (HEV), peuvent etre responsables de manifestations cliniques allant d’une fievre non specifique a des infections du systeme nerveux central, les nouveau-nes etant les plus a risque d’infections graves. Pourtant, la recherche du genome des HPeV n’est pas encore realisee de facon courante dans les laboratoires de virologie clinique. Objectifs Preciser les caracteristiques cliniques et epidemiologiques des infections a HPeV au centre hospitalier de Versailles. Methodes La recherche du genome des HPeV a ete realisee retrospectivement par reverse transcription polymerase chain reaction (RT-PCR) dans 380 liquides cephalorachidiens (LCR) de patients, dont 256 enfants, ayant presente une suspicion d’infection neuromeningee entre le 1 er janvier 2007 et le 31 aout 2011. L’identification des HPeV a ete realisee par genotypage. Resultats Le genome des HPeV a ete detecte dans le LCR de 9 (2,4 %) enfants âges de moins de 2 ans (mediane = 30 j, extremes : 8 j – 18 mois). Les signes cliniques les plus frequemment observes etaient la fievre (100 %) et une irritabilite (8/9, 89 %). Les analyses cytologiques et biochimiques du LCR etaient normales. Il s’agissait du type 3 pour les 6 enfants pour lesquels le genotypage a ete possible. Conclusion Cette etude montre l’interet de la recherche du genome des HPeV dans le LCR des enfants de moins de 2 ans presentant une suspicion d’infection neuromeningee. L’introduction du diagnostic rapide des infections a HPeV permet d’augmenter le champ diagnostique des causes d’infections neuromeningees chez le jeune enfant et d’ameliorer ainsi leur prise en charge.

Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.

Neurological complications of influenza A(H1N1) have been reported in several patients since the onset of the pandemic in 2009. However, meningococcal disease complicating influenza A(H1N1) has not been reported. Two patients were admitted to an intensive care unit (ICU) for altered mental status, fever, and rapidly spreading petechial purpura. They were diagnosed with meningococcal meningitis and/or meningococcemia and influenza A(H1N1) co-infection. Meningococcal disease presenting as meningitis and/or meningococcemia is among the potential complications of influenza A(H1N1) infection. Physicians should be aware of this co-infection, as it must be detected and treated promptly with antibiotics in addition to supportive care.

Febrile infants under 3 months of age are often treated with broad-spectrum intravenous antibiotics while awaiting culture results, to prevent mother-to-child bacterial infections. Human parechoviruses (HPeV) have recently been described as etiologic agents of meningitis and severe sepsis in neonates and young infants. They are rarely investigated and are therefore probably underestimated. They cause acute clinical symptoms that can incorrectly suggest a bacterial infection. In the present case, a 6-week-old infant infected with HPeV developed severe sepsis, complicated by hepatic cytolysis, meningitis, acute renal failure, and mild hemophagocytic lymphohistiocytosis. HPeV type 3 was found by routine specific RT-PCR in cerebrospinal fluid, stools, and plasma. The outcome was spontaneously favorable after 4 days. Early diagnosis of the HPeV infection by routine specific RT-PCR reduces unnecessary antibiotic use and extended hospitalization in febrile young infants.

Introduction La recherche de virus respiratoires par PCR est realisee habituellement au laboratoire de virologie, 5 jours sur 7, en une ou deux series quotidiennes. Cependant, en periode d’epidemie grippale, les services cliniques sont demandeurs de plus de flexibilite et de rapidite afin d’orienter les patients de facon efficace. Dans ce contexte, le developpement de la biologie delocalisee apparait comme une solution appropriee. Lors de l’epidemie de grippe 2016–2017, un automate de diagnostic rapide de grippe (Sofia®, Ingen) avait ete mis en place aux urgences afin d’orienter rapidement les patients devant etre hospitalise. Les tests rapides d’orientation diagnostic (TROD) negatifs devaient etre confirmes par une PCR du fait de la sensibilite imparfaite du test. Cependant, le faible taux de TROD negatifs recontroles ulterieurement par PCR standard (32 %), de meme que la difficulte de suivi des resultats par le laboratoire (17 % de resultats non retournes), ont fait envisager l’evaluation d’un second automate, le GenXpert® (Cepheid), avec une solution permettant au laboratoire de recuperer les resultats a distance. Materiels et methodes Comparaison sur 2 periodes epidemiques successives de 2 automates pour le diagnostic rapide de la grippe aux urgences : Sofia® (detection d’antigene par immunofluorescence) et GenXpert® (PCR multiplex en temps reel). Differents parametres ont ete analyses : le nombre de tests realises, le taux de positif par semaine, le delai entre le prelevement et la saisie des resultats dans l’informatique du laboratoire, l’hospitalisation effective des patients. L’impact sur la charge de travail au laboratoire a egalement ete evalue. Resultats Sur un periode epidemique comparable, 428 TROD ont ete realises en 2016–2017, et 580 en 2017–2018. Les taux de positivite globaux etaient respectivement de 27 % et 33 %. Les indications de realisation du test ont ete respectees dans 95 % et 84 % des cas. Les delais moyens de saisie des resultats etaient de 68 et 26 h. Dans le meme temps, 496 et 464 PCR grippe ont ete realisees au laboratoire. En comparaison des periodes epidemiques des annees precedentes, on note une diminution d’environ 30 % du nombre de PCR realisees. Parallelement le nombre de jour necessitant la realisation de 2 series de PCR a considerablement diminue (−100 a 200 % compare aux annees precedentes). Conclusion Cette etude met en evidence l’interet de ce genre de dispositif dans le cadre de l’epidemie de grippe, permettant un rendu des resultats plus rapide et une orientation plus efficace des patients. De plus, au niveau du laboratoire, ce mode de fonctionnement a permis une reduction de la surcharge de travail generee par le contexte epidemique. En termes de fiabilite, de rapidite de disponibilite des resultats sur le serveur et d’allegement de la charge de travail au laboratoire, le GenXpert® nous parait l’automate le plus approprie.

Resume Les hepatites B occultes sont definies par la presence d’ADN du virus de l’hepatite B en l’absence d’antigene HBs detectable. Leur prevalence chez les patients co-infectes par le VIH va de 0 % a 89 % selon les etudes. Les consequences cliniques en sont mal connues. Le but de cette etude est d’evaluer la frequence des hepatites B occultes chez des patients infectes par VIH et de determiner les facteurs favorisant leur survenue. Patients et methodes L’etude retrospective a ete realisee chez 31 patients infectes par le VIH et ayant des anticorps anti-HBc isoles. La quantification de l’ADN du VHB a ete realisee par PCR en temps reel (HBV PCR kit ; Qiagen®) sur 51 echantillons preleves entre 2000 et 2008 (un a trois echantillons par patient) en l’absence de traitement actif sur le VHB. Resultats L’ADN du VHB est detecte chez 22 % des patients. La frequence des hepatites B occultes apparait plus elevee chez les patients co-infectes par le VHC (p = 0,047). Le nombre de CD4 associe aux prelevements avec un ADN du VHB detectable est significativement plus faible que celui associe aux prelevements indetectables pour le VHB. Conclusion La prevalence des hepatites B occultes apparait elevee chez les patients infectes par le VIH et porteurs d’anticorps anti-HBc isoles. Les titres d’ADN viral sont faibles (

Resume But de l’etude Le diagnostic de maladie a cytomegalovirus (CMV) chez le patient immunodeprime est souvent realise par PCR quantitative (Q-PCR) dans le sang bien que la methode de reference reste l’antigenemie pp65. Objectifs Definir la valeur predictive de la Q-PCR par le test CMV R-gene® pour le diagnostic de maladie a CMV et le suivi de l’efficacite du traitement. Comparer les resultats de la Q-PCR a ceux de l’Ag-pp65 et la faisabilite des deux techniques. Patients et methodes La Q-PCR a ete realisee sur des prelevements de sang total congeles a −80 °C (n = 34) de cinq patients avec un diagnostic de maladie a CMV definie par la presence de signes cliniques evocateurs et une Ag pp65 superieure a deux noyaux. Apres extraction, l’ADN a ete quantifie dans chaque echantillon par la Q-PCR quantitative CMV R-gene® selon les recommandations du fabricant. La detection de l’Ag pp65 CMV avait ete realisee avec le reactif CINAkit® (Argene) lors de la reception du prelevement pour 32 echantillons. Resultats Tous les echantillons positifs en Ag pp65 sont positifs en PCR (n = 16). Six echantillons negatifs en Ag pp65 sont positifs en PCR. Les dix autres echantillons sont negatifs par les deux techniques. Les cinetiques des deux marqueurs sous traitement sont superposables. Conclusion Le test CMV R-gene® a une aussi bonne valeur predictive que l’Ag-pp65 tout en etant une technique rapide, et plus facile d’utilisation. Une etude prospective sur un plus grand nombre de patients est necessaire pour definir le seuil de prediction de maladie a CMV.

International audience; Background - Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. Methods - To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. Results - Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. Conclusions - Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. Clinical trials registration - CCTIRS 10.150 and CNIL DR-2010-379.

Objectif. - Les candidoses invasives nosocomiales representent jusqu'a 15 % des infections nosocomiales des patients de reanimation. La mortalite est voisine de celle du choc septique (40-60 %). Les signes cliniques sont peu evocateurs et les hemocultures sont rarement positives. La mesure de l'index de colonisation, des taux seriques de l'antigene mannane et des anticorps anti-Candida sont evalues pour ameliorer le diagnostic. Materiels et methodes. - Nous avons evalue l'interet de ces trois tests en reanimation pour le diagnostic de candidose invasive. L'index de colonisation etait evalue le jour de l'entree en reanimation, puis une fois par semaine. Un echantillon de serum etait recueilli au meme moment pour la determination de l'antigenemie mannane (ELISA Platelia®, Bio-Rad, France), des anticorps IgM anti-Candida (ELISA, Candiquant-lgM®, Biomerica distributed by Biotrin, Lyon, France),et des anticorps totaux anti-Candida (immunofluorescence). Resultats. - Durant les deux ans de l'etude, 75 patients ont ete suivis. Chez les 46 patients medicaux, l'antigenemie etait le test qui avait la meilleure sensibilite et specificite (75 et 57 %) mais ne permettait pas de differencier les patients infectes des non-infectes (Test exact de Ficher: p = 0,240). Chez les 29 patients chirurgicaux, l'index de colonisation permettait de cibler les patients infectes (Test exact de Ficher: p = 0,052). Conclusion. - Les tests serologiques ne permettent pas de differencier les patients infectes des non-infectes en reanimation. Seul l'index de colonisation chez les patients chirurgicaux de reanimation (p = 0,052) permet de cibler les patients infectes, qui se situent parmi ceux qui ont un IC > 0,5.

Febrile infants under 3 months of age are often treated with broad-spectrum intravenous antibiotics while awaiting culture results, to prevent mother-to-child bacterial infections. Human parechoviruses (HPeV) have recently been described as etiologic agents of meningitis and severe sepsis in neonates and young infants. They are rarely investigated and are therefore probably underestimated. They cause acute clinical symptoms that can incorrectly suggest a bacterial infection. In the present case, a 6-week-old infant infected with HPeV developed severe sepsis, complicated by hepatic cytolysis, meningitis, acute renal failure, and mild hemophagocytic lymphohistiocytosis. HPeV type 3 was found by routine specific RT-PCR in cerebrospinal fluid, stools, and plasma. The outcome was spontaneously favorable after 4 days. Early diagnosis of the HPeV infection by routine specific RT-PCR reduces unnecessary antibiotic use and extended hospitalization in febrile young infants.

H-932. American Society for Microbiology, Washington, DC, USA. 10 Nouhin J, Donchai T, Hoang KT et al. Natural polymorphisms of HIV-1 CRF01_AE integrase coding region in ARV-naive individuals in Cambodia, Thailand and Vietnam: an ANRS AC12 working group study. Infect Genet Evol 2011; 11: 38–43. 11 Wainberg MA, Brenner BG. Role of HIV subtype diversity in the development of resistance to antiviral drugs. Viruses 2010; 2: 2493–508. Research letter

To treat poisonings, physicians must rapidly make a diagnosis. As of today, exhaustive data on most frequently reported toxics are not available in France.This was a retrospective study of announced substances at patients' admissions in intensive care unit for poisoning in 2011 at Lariboisière hospital. Announced substances were collected from anamnesis reported in patient medical records. Verbatims were harmonized and substances classified in medicinal products and three categories of non-medicinal products (recreational/addictive drugs, others, unknown nature).Three hundred and fifteen patients were included, with 891 announced specified substances corresponding to 198 different verbatims. Most of them (83%) are medicinal products (mainly nervous and cardiovascular system molecules). There were 13% of recreational/addictive substances, 3% of other non-medicinal substances. Of the occurrences, 1.5% represent unknown substances.These substances supposedly used in poisoning should be included in toxicology learning programs. Their dosage should be possibly performed in routine by toxicology laboratories.An ongoing study in a prospective and retrospective manner will become an observatory of the substances involved in poisoning.

Human parechoviruses (HPeV), like their counterpart enteroviruses (EV), are associated with clinical manifestations ranging from asymptomatic disease to infections of the central nervous system. Newborn and young infants are particularly at risk for severe infection. In the last 5 years, the molecular diagnosis of HPeV infection in cerebrospinal fluid (CSF) and the identification of the associated HPeV type revealed the specific association between HPeV3 and meningitis or sepsis-like illness in neonates and infants. HPeV infection is not yet routinely diagnosed in clinical virology laboratories.To determine the clinical, biological, and epidemiological characteristics of HPeV infections of patients hospitalized at the Centre Hospitalier de Versailles, France.A total of 380 CSF samples originally referred to our laboratory for enterovirus testing between January 1st, 2007 and August 31st, 2011, were selected and retrospectively screened for the genome detection of HPeV. All HPeV detected were identified by amplification and sequencing of the complete 1D sequence encoding the VP1 protein.The HPeV genome was detected in CSF samples from nine (2.8%) patients. All were young infants under 18 months of age (median, 30 days; age range, 8 days to 18 months). Fever was observed for all children and eight out of nine (89%) presented with irritability. No pleiocytosis and normal glucose and protein levels were observed. The mean duration of the hospital stay was 4 days (range, 2-7 days) and antibiotics were administered to five patients (55.6%). Yearly frequency of genome detection varied remarkably: 1.1% in 2007, 0% in 2008 and 2011, 2.9% in 2009 and 7.1% in 2010. All genotyped viruses were HPeV3.This study confirmed the importance of the HPeV genome detection in CSF samples from patients presenting with sepsis-like illness or suspected infection of the central nervous system, particularly in children under 2 years of age. The introduction of the molecular diagnosis of HPeV infection broadens the panel of diagnosis of neonatal sepsis and central nervous system symptoms in young children. Rapid identification of HPeV by PCR could also contribute to shorter duration of both antibiotic use and hospital stay.

Enteroviruses (EV) are a common cause of aseptic meningitis in children. Virological diagnosis of EV meningitis is currently based on the detection of the viral genome in the cerebrospinal fluid (CSF). This study attempted to determine the correlation and the temporality of the polymerase chain reaction (PCR) assay in serum and CSF and to evaluate the possibility of diagnosing EV infection only on the serum PCR. The EV genome was sought by RT real-time PCR (Smart Cycler EV Primer and Probe Set(®), Cepheid) in CSF and serum, collected at the same time, for all children who underwent a lumbar puncture for suspected meningitis, between 1 June and 31 July 2010 at the Versailles Hospital. Forty-four patients were included in the study. EV infection was documented for 22 of them. In 10 patients, the EV genome was detected in CSF only; in 3 patients in serum only, and in 9 patients in both. Among patients with acute EV neurological infection, viremic children were significantly younger (1.6 months versus 5.8 years; P0.001). Viremia was detected when the serum was sampled within 30 h after the beginning of symptoms. These results confirm previous reports of early and transient viremia in young children. This preliminary study shows the limits and added value of EV PCR in serum. It suggests that in some children and under certain conditions (age3 months, clinical and biological compatibility with a viral infection, no previous antibiotic therapy, time from symptom onset to blood sampling30 h, PCR in serum analyzed within 3h), PCR in serum, when positive, is a possible alternative. Therefore, it may be possible to diagnose EV infection without performing a lumbar puncture in a limited number of young children (11.4% of our suspected cases). This study needs to be reinforced by a multicenter study with a broader panel of patients.

Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.

Diagnosing the presence of cytomegalovirus (CMV) in the blood of immunodepressed patients is often done by quantitative polymerase chain reaction (Q-PCR) even though the reference method remains the antigenemia pp65 (Ag-pp65) test.To define the predictive value of the Q-PCR in the diagnosis of CMV disease and assess treatment efficacy using the CMV R-gene test. To compare the Q-PCR results and feasibility with those of the Ag-pp65 test.The Q-PCR was performed in 34 whole blood samples (frozen at -80 degrees C until use) from five patients diagnosed with CMV disease, defined as the presence of clinical signs and Ag-pp65 in the nuclei of more than two cells. After extraction, viral DNA was quantified in each sample using the Q-PCR CMV R-gene kit according to the manufacturer's instructions. Immediately after blood was drawn, the Ag-pp65 test had been performed in 32 samples using CINAkit (Argene).The 16 samples positive by the Ag-pp65 test were also positive by PCR; six samples negative by the Ag-pp65 test were positive by PCR; and the remaining 10 samples were negative by both techniques. During treatment, the two markers' kinetics were similar.The CMV R-gene test has a predictive value as good as that of the Ag-pp65 test but is fast and easier to use. A prospective study with a greater number of patients is needed to define the prediction threshold for CMV disease.

Occult hepatitis B is defined as the presence of hepatitis B virus (HBV) DNA in the absence of detectable HBs antigen. The prevalence of occult hepatitis B among patients HIV-infected is uncertain, varying between 0% and 89%, and the clinical consequences of the coinfection are poorly known. The aim of this study was to evaluate the frequency of occult hepatitis B among HIV-infected patients and determine risk factors.This retrospective study was conducted with plasma samples from 31HIV-infected patients untreated for HBV infection and for whom at least one sample was available. All patients were found to be carriers of isolated anti-HBc antibodies between 2000 and 2008, and HBV DNA was quantified in 51 samples (one to three per patient) by real-time PCR using the Qiagen HBV PCR kit.HBV DNA was found in samples from seven patients (22%). Occult hepatitis B seemed to be more frequent among patients coinfected with HCV (p=0.047). The number of CD4 cells was significantly less in samples containing detectable HBV DNA than in those with no detectable HBV DNA.The prevalence of occult hepatitis B seemed high, and HBV DNA titers were weak (20UI/mL), among patients infected with HIV and carrying isolated anti-HBc antibodies. These results would support screening HIV-infected patients for the presence of HBV DNA if confirmed with a larger patient population.

In both ELETTRA and the Swiss Light Source (SLS), a complementary 3rd harmonic (1.5 GHz) idle superconducting RF system has been recently implemented and commissioned, in order to lengthen the bunches and therefore improve the Touschek dominated beam lifetime. Here below we report on the commissioning results.

Several authors proposed the construction of superconducting proton linacs using the LEP2 cavities once LEP will be decommissioned. However only a fraction (about half) of these cavities can be used as they are for the high-energy part (/spl beta//spl sim/1) of such a linac, the low energy part requiring the development of accelerating structures optimized for lower values of the particle velocity. At CERN an R&D programme on reduced-/spl beta/ single-cell cavities started in 1996 in order to study and explore the limits of the technology successfully used for the production of LEP2 cavities (copper cavities niobium-plated using the magnetron sputtering technique). Four different geometries were extensively investigated, each representing part of a multicell structure optimized for particles having /spl beta/=0.48, /spl beta/=0.625, /spl beta/=0.66 and /spl beta/=0.8 respectively. The results were encouraging for the last two types and therefore a new phase of R&D aimed at the production of multicell cavities for /spl beta/=0.66 and /spl beta/=0.8 was started. The goal is to demonstrate simultaneously the feasibility of such cavities and the possibility of producing them by low-cost modification of LEP cavities. In the paper, after a brief review of the results obtained on the single-cell cavities, we present in more detail the procedure for the transformation of the LEP cavities, which should allow a realistic estimate of the costs of such operation.