Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice

In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.

Near-wall hemodynamic parameters of finger arteries altered by hand-transmitted vibration

BACKGROUND

Sustained exposure to high-level hand-transmitted vibrations may result in angioneurotic disorders, which partly originate from vibration-altered hemodynamics in the finger arteries when repeating these disturbances throughout working life. Hence, the aim of this study is to assess the most relevant hemodynamic descriptors in the digital arteries, determine the relationship between the latter and vibration features, and gain better understanding of the physiological mechanisms involved.

METHODS

An experimental setup, mainly comprised of an ultra-high frequency ultrasound scanner and a vibration shaker, was used to image the digital proper volar arteries of the forefinger. Raw ultrasound data were post-processed by custom-made numerical routines to supply a pulsatile fluid mechanics model for computing the hemodynamic descriptors. Twenty-four healthy volunteers participated in the measurement campaign. Classical statistical methods were then applied to the dataset and also the wavelet transform for calculating the signal power in the frequency bands matching cardiac, respiratory, myogenic and neurogenic activities.

RESULTS

The artery diameter, the wall shear stress - WSS - and the WSS temporal gradient - WSSTG - were found to be the most relevant descriptors. Vibration-induced WSS was divided by three compared to its basal value whatever the vibration frequency and it was proportional to log2 of the acceleration level. Marked increases in WSSTG when stopping vibration might also lead to adverse health effects. Vibration caused a drop in WSS power for the frequency band associated with the neurogenic activity of the sympathetic nervous system.

CONCLUSION

This study may pave the way for a new framework to prevent vibration-induced vascular risk.

Infection nosocomiale et clusters intra hospitalier d'infection à SARS cov 2 dans un centre hospitalier Général : Bilan d'une année de pandémie

Introduction

La mise à disposition large des tests PCR SARS cov2 et la stratégie de dépistage systématique autour d'un cas a permis de mettre en évidence la survenue de transmissions croisées entrainant des infections nosocomiales au sein des services de soins. Un cluster est défini par la présence d'au moins 3 cas dans un service de soins dans un délai de 14 jours. L'objectif de l'étude est de définir le nombre de cas d'infection nosocomiale et de phénomène de cluster hospitalier aux décours de la 2ème et 3ème vague d'infection à SARS cov 2 dans un centre hospitalier Général.

Matériels et méthodes

Etude rétrospective des infections nosocomiales et des clusters intra hospitalier entre avril 2020 et avril 2021 L'infection nosocomiale est définie par la négativité d'une PCR d'entrée et la positivité d'une PCR à plus de 7 jours de l'entrée. Un cluster est défini par au moins trois cas d'infection nosocomiale dans une même unité de lieux et de temps (14jours). La deuxième vague comprend les cas identifiés entre les mois d'octobre et décembre 2020 et janvier avril 2021 pour la troisième.

Résultats

Quatre mille deux cents cinq PCR positives ont été détectées entre avril 2020 et avril 2021. Le nombre covid nosocomiaux était de 123 des 1654 patients hospitalisés (7.4 %) et ayant un diagnostic virologique d'infection à SARScov2. Cent onze (79 %) des cas nosocomiaux étaient liés à des clusters. Durant la deuxième vague, 14 clusters ont été détectés dans 8 services différents (moyenne de 5 patients par épisodes avec au minimum 3 et au maximum 18 patients par cluster). Pendant la troisième vague, 4 clusters ont été identifiés dans 4 services. La durée moyenne de résolution des clusters a été de 14 jours. Les clusters ont été détectés pour 58 cas (47 %)en secteur médecine chirurgie obstétrique et pour 65 (53 %) cas en secteur soins de suite et rééducation.

La moyenne d'âge des cas nosocomiaux était de 83 ans, 85,37 % présentaient au moins une comorbidité et la mortalité a été de 22,76 % contre 19 % pour les cas communautaire (Xhi² = 1.03 NS).

Conclusion

L'acquisition nosocomiale du virus SARS cov 2 a été est un phénomène bien réel entrainant une surmortalité en milieu hospitalier. Ces données patients permettent de justifier les mesures spécifiques comme la vaccination précoce et obligatoire des personnels soignants et des patients à risque, un renforcement des mesures d'hygiène et un contrôle des visites.

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Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School

Introduction

The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely.

Objectives

To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19.

Methods

The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a “breaking the ice session” one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty.

Results

Participants were divided on a voluntary basis into three working groups: 1) “Drug repurposing: overcoming challenges in pharmacoepidemiology” 2) “Psychopathological research in psychiatry”; 3) “How to conduct a cross-sectional survey?”. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants.

Conclusions

Although the remote format limits social interactions during the Summer School, overall participants’ high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

Disclosure

No significant relationships.

Making the most out of the EPA Research Summer School: from a group exercise to an international collaborative study protocol

Introduction

The 2021 Research Summer School took place virtually, and 7 psychiatric trainees or early career psychiatrists (ECPs) from 7 different European countries participated in a working group on how to conduct a cross-sectional survey study.

Objectives

To provide an overview of the process of developing an internationally collaborative protocol during the EPA Virtual Research Summer School.

Methods

All participants were asked by the Faculty mentor chairing this working group to write a research question that could be investigated through a cross-sectional survey. After a brainstorming discussion, it was decided to investigate the experiences, knowledge, and attitudes of psychiatric trainees and ECPs about electroconvulsive therapy (ECT) in Europe, an effective yet controversial procedure.

Results

The process of developing a protocol entailed different phases. First, a literature search was conducted, which supported the need to explore more the attitudes towards ECT among ECPs. Through group discussion the study’s objectives were decided, as well as the most appropriate methodology (including data collection and questionnaire use). At the end of the course, the core of the research plan was presented to all participants at the Research Summer School, preceding its implementation.

Conclusions

Participating in the EPA Research Summer School is a unique experience, a great learning opportunity, and can also lead to fruitful collaborations. It enabled the learning of the key aspects of designing and conducting a survey. In a short period of time, it was possible to design a study protocol for a future international cross-sectional survey on ECT.

Disclosure

No significant relationships.

The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study

OBJECTIVE

To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care.

DESIGN

Multicentre prospective observational study.

SETTING

Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region.

POPULATION

All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016.

METHODS

Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously.

MAIN OUTCOME MEASURE

Final decision reached following discussions in the antenatal period.

RESULTS

We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan.

CONCLUSIONS

Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy.

TWEETABLE ABSTRACT

Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.

Psychological impact of the SARS-CoV-2 outbreak on the staff of a French hospital

Background

The outbreak of SARS-CoV-2 has resulted in anxiety, depression and post-traumatic stress disorder (PTSD) among hospital staff. The factors associated with this psychological impact remain to be determined.

Methods

A cross-sectional study using an online questionnaire completed by the staff of a French hospital, two months after the SARS-CoV-2 outbreak.

Results

Among the 353 participants (of whom 67% were healthcare professionals), 32% had symptoms of anxiety, 16% of depression and 16% of PTSD. Eleven per cent had initiated or increased treatment with sleeping pills, and 6% with anxiolytics. In a multivariate analysis, factors independently associated with anxiety were: change of professional team, having a relative infected by SARS-CoV-2 and a new/increased treatment with sleeping pills or anxiolytics. The only factor associated with depression was the feeling of risk during professional practice. The factors associated with PTSD were: having a relative infected by SARS-CoV-2, the feeling of risk during professional practice, the increase in smoking and treatment with sleeping pills. The observance of transmission preventive measures (TPM) was not associated with the psychological impact of SARS-CoV-2. A personal history of SARS-CoV-2 infection and age < 36 years were associated with insufficient use of protective equipment. Age < 36 years, and being a healthcare professional were associated with the non-observance of social distancing.

Conclusion

The hospital staff displayed psychological consequences, resulting in the use of anxiolytics and sleeping pills. Belonging to a group with low-risk of severe disease was associated with lower observance of TPM.

A three-dimensional visco-hyperelastic FE model for simulating the mechanical dynamic response of preloaded phalanges

This study lays the groundwork for a multi-scale strategy that will lead to a better understanding and prediction of the effects of vibration on the digital arterial network. This is accomplished by modelling the mechanical and biological factors that could disturb the basal vasoconstriction balance in the fingertip. The first stage of this novel approach involved building and validating an original dissipative constitutive law for the fingertip soft tissue for the purpose of finite element modelling of the mechanical response of preloaded phalanges in vibration. This visco-hyperelastic constitutive law was established by means of a two-stage procedure for combining a classical pure static nonlinear law with an original dissipative model. First, the parameters of an Ogden-Hill pure static nonlinear constitutive law were identified using a constrained optimisation algorithm. Second, an original viscous dissipation model was proposed in the spectral domain. This model is based on the linearization of the nonlinear quasi-linear viscoelasticity law and the use of a viscoelastic relaxation modulus, expressed as a continuous distribution of relaxation spectra suitable for living tissues. The experimental data used to fit this model were the static and dynamic stiffnesses of preloaded fingertips acquired from a group of 20 subjects. The relative errors between the measured and simulated stiffnesses were less than 5% in the static procedure and approximately 8% using dynamic analysis. The computed mechanical pressure and maximal tangential stress within the fingertip were high in the soft tissues close to the vibration excitation and also in the bones and interphalangeal cartilages far from the vibration source. Mechanical power was only dissipated significantly in the immediate vicinity of the contact area between the probe and the finger. The main contribution of this study was to implement and identify the parameters of a new spectral dissipative law for fingertip soft tissues. This work may apply in occupational health for modifying the vibration dose assessment or for the follow-up and screening of connective tissue diseases.

Molecular Epidemiology of Blastocystis sp. in Various Animal Groups from Two French Zoos and Evaluation of Potential Zoonotic Risk

Blastocystis sp. is a common intestinal parasite infecting humans and a wide range of animals worldwide. It exhibits an extensive genetic diversity and 17 subtypes (STs) have thus far been identified in mammalian and avian hosts. Since several STs are common to humans and animals, it was proposed that a proportion of human infections may result from zoonotic transmission. However, the contribution of each animal source to human infection remains to be clarified. Therefore, the aim of this study was to expand our knowledge of the epidemiology and host specificity of this parasite by performing the largest epidemiological survey ever conducted in animal groups in terms of numbers of species screened. A total of 307 stool samples from 161 mammalian and non-mammalian species in two French zoos were screened by real-time PCR for the presence of Blastocystis sp. Overall, 32.2% of the animal samples and 37.9% of the species tested were shown to be infected with the parasite. A total of 111 animal Blastocystis sp. isolates were subtyped, and 11 of the 17 mammalian and avian STs as well as additional STs previously identified in reptiles and insects were found with a varying prevalence according to animal groups. These data were combined with those obtained from previous surveys to evaluate the potential risk of zoonotic transmission of Blastocystis sp. through the comparison of ST distribution between human and animal hosts. This suggests that non-human primates, artiodactyls and birds may serve as reservoirs for human infection, especially in animal handlers. In contrast, other mammals such as carnivores, and non-mammalian groups including reptiles and insects, do not seem to represent significant sources of Blastocystis sp. infection in humans. In further studies, more intensive sampling and screening of potential new animal hosts will reinforce these statements and expand our understanding of the circulation of Blastocystis sp. in animal and human populations.

Genome-Wide Association Study of Acute Renal Graft Rejection

Acute renal rejection is a major risk factor for chronic allograft dysfunction and long-term graft loss. We performed a genome-wide association study to detect loci associated with biopsy-proven acute T cell-mediated rejection occurring in the first year after renal transplantation. In a discovery cohort of 4127 European renal allograft recipients transplanted in eight European centers, we used a DNA pooling approach to compare 275 cases and 503 controls. In an independent replication cohort of 2765 patients transplanted in two European countries, we identified 313 cases and 531 controls, in whom we genotyped individually the most significant single nucleotide polymorphisms (SNPs) from the discovery cohort. In the discovery cohort, we found five candidate loci tagged by a number of contiguous SNPs (more than five) that was never reached in iterative in silico permutations of our experimental data. In the replication cohort, two loci remained significantly associated with acute rejection in both univariate and multivariate analysis. One locus encompasses PTPRO, coding for a receptor-type tyrosine kinase essential for B cell receptor signaling. The other locus involves ciliary gene CCDC67, in line with the emerging concept of a shared building design between the immune synapse and the primary cilium.

Use of near infrared reflectance spectroscopy to predict phytate phosphorus, total phosphorus, and crude protein of common poultry feed ingredients

The purpose of the study that is presented herein was to develop near-infrared reflectance spectroscopy (NIRS) calibrations to predict total phosphorus (P), phytate-P, and protein concentrations of feed ingredients commonly used in monogastric feed formulation. Samples representing 14 vegetable ingredients (cereals, cereal by-products, and oilseed meals) were collected worldwide throughout 2013. The samples were assayed by standard wet chemical techniques for total P, phytate-P, and protein content. There was substantial variability in protein, phytate-P, and total P within and between ingredients used in the calibration set. Protein content varied from 76 to 487 g/kg. Total P ranged from 2.09 and 22.5 g/kg and phytate-P ranged from 0.99 and 13.8 g/kg. Within these broad ranges, NIRS values were highly correlated for determination of protein, total P, and phytate-P with a standard error of prediction equal to 9.06 g/kg, 0.80 g/kg, and 0.66 g/kg, respectively. The wide diversity and heterogeneity of the mix of feed ingredients allowed the development of NIRS calibrations of sufficient accuracy to help nutritionists control the nutritional composition of their feed.

Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study

We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.

What do Pneumocystis organisms tell us about the phylogeography of their hosts? The case of the woodmouse Apodemus sylvaticus in continental Europe and western Mediterranean islands

Pneumocystis fungi represent a highly diversified biological group with numerous species, which display a strong host-specificity suggesting a long co-speciation process. In the present study, the presence and genetic diversity of Pneumocystis organisms was investigated in 203 lung samples from woodmice (Apodemus sylvaticus) collected on western continental Europe and Mediterranean islands. The presence of Pneumocystis DNA was assessed by nested PCR at both large and small mitochondrial subunit (mtLSU and mtSSU) rRNA loci. Direct sequencing of nested PCR products demonstrated a very high variability among woodmouse-derived Pneumocystis organisms with a total number of 30 distinct combined mtLSU and mtSSU sequence types. However, the genetic divergence among these sequence types was very low (up to 3.87%) and the presence of several Pneumocystis species within Apodemus sylvaticus was considered unlikely. The analysis of the genetic structure of woodmouse-derived Pneumocystis revealed two distinct groups. The first one comprised Pneumocystis from woodmice collected in continental Spain, France and Balearic islands. The second one included Pneumocystis from woodmice collected in continental Italy, Corsica and Sicily. These two genetic groups were in accordance with the two lineages currently described within the host species Apodemus sylvaticus. Pneumocystis organisms are emerging as powerful tools for phylogeographic studies in mammals.

[Incarceration of the retroverted uterus in the third trimester: report of 2 cases]

Incarceration of the retroverted gravid uterus in the third trimester is a rare but distinctive diagnosis. Initial symptoms are more frequently urinary and digestive symptoms which became more acute at the third trimester. Severe abdominal pain associated with bleeding in early labor leads to make the diagnosis during an emergency cesarean section. However, the typical features of the clinical transvaginal exam and the abdominal ultrasound exam can confirm easily this diagnosis. We report two additional cases where Joël-Cohen incision for cesarean section was possible after manual reposition of the uterus. We discuss the diagnostic approach and the management regarding a literature review.

Effects of Ar-H2-N2 microwave plasma on chitosan and its nanoliposomes blend thin films designed for tissue engineering applications

This work addresses the functionalization of chitosan thin films and its nanoliposomes blend films by a microwave-excited Ar/N2/H2 surface-wave plasma treatment which was found an effective tool to modify surface properties. Changes in the film properties (wettability, chemical composition, morphology) induced by the plasma treatment are studied using water contact angle measurements, X-ray photoelectron spectroscopy and scanning probe microscopy. The results suggest that hydrophilicity of the films is improved by plasma treatment in a plasma condition dependency manner. Water contact angle of chitosan films before and after plasma treatment are, respectively, 101° and 27°. Besides chemical changes on the surface, the nanoliposomes incorporation and plasma treatment also induce morphological modifications. Moreover, a correlation is found between the nanoliposomes composition and size, and the effects of plasma treatment. It is shown that the plasma treatment significantly improves the chitosan film functionalization. The effect of N2 content (88% and 100%) in the plasma gas mixture on the film etching is also pointed out.

The natural history of clinical operational tolerance after kidney transplantation through twenty-seven cases

We report here on a European cohort of 27 kidney transplant recipients displaying operational tolerance, compared to two cohorts of matched kidney transplant recipients under immunosuppression and patients who stopped immunosuppressive drugs and presented with rejection. We report that a lower proportion of operationally tolerant patients received induction therapy (52% without induction therapy vs. 78.3%[p = 0.0455] and 96.7%[p = 0.0001], respectively), a difference likely due to the higher proportion (18.5%) of HLA matched recipients in the tolerant cohort. These patients were also significantly older at the time of transplantation (p = 0.0211) and immunosuppression withdrawal (p = 0.0002) than recipients who rejected their graft after weaning. Finally, these patients were at lower risk of infectious disease. Among the 27 patients defined as operationally tolerant at the time of inclusion, 19 still display stable graft function (mean 9 ± 4 years after transplantation) whereas 30% presented slow deterioration of graft function. Six of these patients tested positive for pre-graft anti-HLA antibodies. Biopsy histology studies revealed an active immunologically driven mechanism for half of them, associated with DSA in the absence of C4d. This study suggests that operational tolerance can persist as a robust phenomenon, although eventual graft loss does occur in some patients, particularly in the setting of donor-specific alloantibody.

Mixed human intra- and inter-subtype infections with the parasite Blastocystis sp

Because of their limitations, current subtyping methods likely underestimate mixed human intra- and inter-subtype infections with Blastocystis sp. leading to erroneous data in the context of epidemiological studies. We confirmed this hypothesis by the identification of several isolates belonging to three subtypes in a patient considered at high risk of mixed infection through her lifestyle in rural area and long history of travelling.

Phenotype-genotype correlation and follow-up in adult patients with hypokalaemia of renal origin suggesting Gitelman syndrome

INTRODUCTION

Gitelman syndrome (GS) is a tubulopathy caused by SLC12A3 gene mutations, which lead to hypokalaemic alkalosis, secondary hyperaldosteronism, hypomagnesaemia and hypocalciuria.

AIM

The aim of this study was to assess the prevalence of SLC12A3 gene mutations in adult hypokalaemic patients; to compare the phenotype of homozygous, heterozygous and non-mutated patients; and to determine the efficiency of treatment.

METHODS

Clinical, biological and genetic data were recorded in 26 patients.

RESULTS

Screening for the SLC12A3 gene detected two mutations in 15 patients (six homozygous and nine compound heterozygous), one mutation in six patients and no mutation in five patients. There was no statistical difference in clinical symptoms at diagnosis between the three groups. Systolic blood pressure tended to be lower in patients with two mutations (P=0.16). Hypertension was unexpectedly detected in four patients. Five patients with two mutated alleles and two with heterozygosity had severe manifestations of GS. Significant differences were observed between the three groups in blood potassium, chloride, magnesium, supine aldosterone, 24 h urine chloride and magnesium levels and in modification of the diet in renal disease. Mean blood potassium levels increased from 2.8 ± 0.3, 3.5 ± 0.5 and 3.2 ± 0.3 before treatment to 3.2 ± 0.5, 3.7 ± 0.6 and 3.7 ± 0.3 mmol/l with treatment in groups with two (P=0.003), one and no mutated alleles respectively.

CONCLUSION

In adult patients referred for renal hypokalaemia, we confirmed the presence of mutations of the SLC12A3 gene in 80% of cases. GS was more severe in patients with two mutated alleles than in those with one or no mutated alleles. High blood pressure should not rule out the diagnosis, especially in older patients.

[Minimize kidney failure in transplantation patients with proliferation signal inhibitors]

Chronic renal dysfunction is a multifactorial and frequent event after organ transplantation. The measurement or the estimation of glomerular filtration rate is essential to detect early progressive renal dysfunction. Proliferation signal inhibitors are nonnephrotoxic immunosuppressive drugs which may be useful to minimize calcineurin inhibitors-related side effects through a conversion strategy. Most studies in the setting of kidney transplantation showed improvement in glomerular filtration rate as high than conversion was early. Proliferation signal inhibitors may be included quickly in new immunosuppressive regimen for liver transplanted patients with chronic renal dysfunction.

Molecular characterization of a new Tetratrichomonas species in a patient with empyema

A new Tetratrichomonas species was identified by molecular and phylogenetic approaches in the pleural fluid from a patient with encysted empyema leading to dyspnea. This observation raised the questions of the real prevalence of pulmonary trichomonosis in humans, the zoonotic potential of trichomonads, and the existence of human-host-adapted strains.

[Immunosuppressive strategies and chronic graft dysfunction in kidney transplantation]

Chronic graft dysfunction is a major cause of return to dialysis. In the majority of cases, it is correlated with histological signs of cellular and/or humoral rejection, the nephrotoxicity of anticalcineurins, or nonspecific lesions of interstitial fibrosis and tubular atrophy. Although the incidence of acute rejection has considerably decreased, renal toxicity of the calcineurin inhibitors remains problematic. In cases of established nephrotoxicity, the use of non-nephrotoxic immunosuppressors such as mycophenolic acid or the proliferation signal inhibitors makes it possible to reduce or even stop the anticalcineurins. In prevention of anticalcineurin nephrotoxicity, many attempts to minimize or wean patients from them have shown that improvement in renal function is only obtained at the cost of an increase in the incidence of acute rejection. This makes it necessary to select patients who may benefit from anticalcineurin-sparing treatment, based on clinical, histological, and biological markers. Finally, long-term follow-up is also fundamental in order to validate the positive impact on renal function of this strategy in terms of graft survival.