Precise genome editing underlines the distinct contributions of mutations in ERG11, ERG3, MRR1, and TAC1 genes to antifungal resistance in Candida parapsilosis

Candida parapsilosis has recently emerged as a major threat due to the worldwide emergence of fluconazole-resistant strains causing clonal outbreaks in hospitals and poses a therapeutic challenge due to the limited antifungal armamentarium. Here, we used precise genome editing using CRISPR-Cas9 to gain further insights into the contribution of mutations in ERG11, ERG3, MRR1, and TAC1 genes and the influence of allelic dosage to antifungal resistance in C. parapsilosis. Seven of the most common amino acid substitutions previously reported in fluconazole-resistant clinical isolates (including Y132F in ERG11) were engineered in two fluconazole-susceptible C. parapsilosis lineages (ATCC 22019 and STZ5). Each mutant was then challenged in vitro against a large array of antifungals, with a focus on azoles. Any possible change in virulence was also assessed in a Galleria mellonella model. We successfully generated a total of 19 different mutants, using CRISPR-Cas9. Except for R398I (ERG11), all remaining amino acid substitutions conferred reduced susceptibility to fluconazole. However, the impact on fluconazole in vitro susceptibility varied greatly according to the engineered mutation, the stronger impact being noted for G583R acting as a gain-of-function mutation in MRR1. Cross-resistance with newer azoles, non-medical azoles, but also non-azole antifungals such as flucytosine, was occasionally noted. Posaconazole and isavuconazole remained the most active in vitro. Except for G583R, no fitness cost was associated with the acquisition of fluconazole resistance. We highlight the distinct contributions of amino acid substitutions in ERG11, ERG3, MRR1, and TAC1 genes to antifungal resistance in C. parapsilosis.

Sustained xanthophyll pigments-related photoprotective NPQ is involved in photoinhibition in the haptophyte Tisochrysis lutea

Dynamic xanthophyll cycle (XC) related non-photochemical quenching (NPQd, also called qE) is present in most phototrophs. It allows dissipating excess light energy under adverse growing conditions. Generally, NPQd rapidly reverses for photosynthesis to resume when light intensity decreases back toward optimal intensity. Under certain environmental conditions and/or in some species, NPQ can be strongly sustained (NPQs showing hours-to-days relaxation kinetics). Tisochrysis lutea is a South Pacific haptophyte phytoplankton with a strong potential for aquaculture and biotechnology applications. It was previously reported to show a surprisingly low NPQd capacity while synthesizing large amounts of diatoxanthin (Dt), a pigment involved in the XC. In order to better understand this paradox, we investigated the characteristics of NPQ in T. lutea under various growth conditions of light and nutrient availability (different photoperiods, low and high light, nutrient starvations). We found a strong NPQs, unmeasurable with usual fluorometry protocols. Along with confirming the involvement of Dt in both NPQd and NPQs (by using the dithiothreitol inhibitor), we highlighted a strong relationship between Dt and the maximum quantum yield of photochemistry (Fv/Fm) across growing conditions and during relaxation experiments in darkness. It suggests that changes in Fv/Fm, usually attributed to the 'photoinhibitory' quenching (qI), are simultaneously largely impacted by photoprotective NPQ. The overlap of xanthophyll pigments-related photoprotective NPQ with several other mechanisms involved in the cell response (Photosystem II photoinactivation, changes in pigments composition, and detoxification by antioxidants) to energy unbalance is further discussed. Our findings question both how widespread NPQs is in the global ocean, particularly in nutrient starved environments (oligotrophic waters) and situations (post-bloom), and the use of adapted active fluorescence protocols (i.e. with extended NPQ relaxation period prior to measurement).

A radio-detected type Ia supernova with helium-rich circumstellar material

Type Ia supernovae (SNe Ia) are thermonuclear explosions of degenerate white dwarf stars destabilized by mass accretion from a companion star1, but the nature of their progenitors remains poorly understood. A way to discriminate between progenitor systems is through radio observations; a non-degenerate companion star is expected to lose material through winds2 or binary interaction3 before explosion, and the supernova ejecta crashing into this nearby circumstellar material should result in radio synchrotron emission. However, despite extensive efforts, no type Ia supernova (SN Ia) has ever been detected at radio wavelengths, which suggests a clean environment and a companion star that is itself a degenerate white dwarf star4,5. Here we report on the study of SN 2020eyj, a SN Ia showing helium-rich circumstellar material, as demonstrated by its spectral features, infrared emission and, for the first time in a SN Ia to our knowledge, a radio counterpart. On the basis of our modelling, we conclude that the circumstellar material probably originates from a single-degenerate binary system in which a white dwarf accretes material from a helium donor star, an often proposed formation channel for SNe Ia (refs. 6,7). We describe how comprehensive radio follow-up of SN 2020eyj-like SNe Ia can improve the constraints on their progenitor systems.

The Mortality Attributable to Candidemia in C. auris Is Higher than That in Other Candida Species: Myth or Reality?

Candida auris has become a major health threat due to its transmissibility, multidrug resistance and severe outcomes. In a case-control design, 74 hospitalised patients with candidemia were enrolled. In total, 22 cases (29.7%) and 52 controls (C. albicans, 21.6%; C. parapsilosis, 21.6%; C. tropicalis, 21.6%; C. glabrata, 1.4%) were included and analysed in this study. Risk factors, clinical and microbiological characteristics and outcomes of patients with C. auris and non-auris Candida species (NACS) candidemia were compared. Previous fluconazole exposure was significantly higher in C. auris candidemia patients (OR 3.3; 1.15–9.5). Most C. auris isolates were resistant to fluconazole (86.3%) and amphotericin B (59%) whilst NACS isolates were generally susceptible. No isolates resistant to echinocandins were detected. The average time to start antifungal therapy was 3.6 days. Sixty-three (85.1%) patients received adequate antifungal therapy, without significant differences between the two groups. The crude mortality at 30 and 90 days of candidemia was up to 37.8% and 40.5%, respectively. However, there was no difference in mortality both at 30 and 90 days between the group with candidemia by C. auris (31.8%) and by NACS (42.3%) (OR 0.6; 95% IC 0.24–1.97) and 36.4% and 42.3% (0.77; 0.27–2.1), respectively. In this study, mortality due to candidemia between C. auris and NACS was similar. Appropriate antifungal therapy in both groups may have contributed to finding no differences in outcomes.

Acquired fluconazole resistance and genetic clustering in Diutina (Candida) catenulata from clinical samples

OBJECTIVES

Diutina (Candida) catenulata is an ascomycetous yeast isolated from environmental sources and animals, occasionally infecting humans. The aim of this study is to shed light on the in vitro antifungal susceptibility and genetic diversity of this opportunistic yeast.

METHODS

Forty-five D. catenulata strains isolated from various sources (including human and environmental sources) and originating from nine countries were included. Species identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and confirmed via internal transcribed spacer ribosomal DNA barcoding. In vitro antifungal susceptibility was determined for seven systemic antifungals via the gradient strip method after 48 hours of incubation at 35°C using Etest® (Biomérieux) or Liofilchem® strips. Isolates exhibiting fluconazole minimal inhibitory concentrations (MICs) of ≥8 μg/mL were investigated for mutations in the ERG11 gene. A novel microsatellite genotyping scheme consisting of four markers was developed to assess genetic diversity.

RESULTS

MIC ranges for amphotericin B, caspofungin, micafungin, isavuconazole, and posaconazole were 0.19-1 μg/mL, 0.094-0.5 μg/mL, 0.012-0.064 μg/mL, 0.003-0.047 μg/mL, and 0.006-0.032 μg/mL, respectively. By comparison, a broad range of MICs was noted for fluconazole (0.75 to >256 μg/mL) and voriconazole (0.012-0.38 mg/L), the higher values being observed among clinical strains. The Y132F amino acid substitution, associated with azole resistance in various Candida species (C. albicans, C. tropicalis, C. parapsilosis, and C. orthopsilosis), was the main substitution identified. Although microsatellite typing showed extensive genetic diversity, most strains with high fluconazole MICs clustered together, suggesting human-to-human transmission or a common source of contamination.

DISCUSSION

The high rate of acquired fluconazole resistance among clinical isolates of D. catenulata is of concern. In this study, we highlight a link between the genetic diversity of D. catenulata and its antifungal resistance patterns, suggesting possible clonal transmission of resistant isolates.

Otomycosis caused by the cryptic and emerging species Aspergillus sydowii: two case reports

Two cases of otomycosis have been reported in patients undergoing tympanomastoidectomy. The first one had chronic otitis media, hypertrophic concha and nasal septum deviation, tympanic perforation and otorrhea. The second had otalgia, pruritus, chronic otitis media and cholesteatoma. Direct examination showed mycelial septate filaments with a branch at an angle close to 45°, later identified as Aspergillus sydowii by sequencing the BenA and CaM genes. Susceptibility testing showed low MIC of amphotericin B, itraconazole, ketoconazole and ciclopirox olamine. In both cases, ketoconazole was instituted for 10 days. Otomycosis is a challenge as it is primarily recurrent in patients undergoing surgery. The clinical implication, the identification of the emerging pathogen and the determination of MIC were necessary for the knowledge of the epidemiological profile and establishment of the treatment.

Precise editing using CRISPR-Cas9 to explore the contribution of clinically-derived mutations to antifungal resistance in the pathogenic yeast Candida parapsilosis

Introduction

Candida parapsilosis is both a commensal/saprophytic yeast of the human skin and an opportunistic pathogen which can be responsible for life-threatening infections. The increasing reports of clonal outbreaks involving azole-resistant C. parapsilosis in the clinical setting is worrisome and urges for a better understanding of antifungal resistance in this species. Previous studies have identified mutations in key genes which can explain acquired fluconazole resistance. Reverse genetics approaches are now warranted to confirm their involvement and to determine whether they can affect other clinically-licensed antifungals. Here, we used a CRISPR-Cas9 technique to study the relative contributions of clinically-derived mutations to antifungal resistance and provide answers to these questions.

Materials and Methods

Six clinically-derived mutations were selected (ERG11Y132F, ERG11K143R,ERG11R398I, TAC1G650E, MRR1G583R, ERG3G111R) to be engineered in two C. parapsilosis fluconazole-susceptible backgrounds (ATCC22019, STZ5) using a previously described CRISPR-Cas9 method. In vitro susceptibility of the transformants to fluconazole, voriconazole, posaconazole, isavuconazole and micafungin was determined by Etest®.

Results/Discussion

The impact on fluconazole susceptibility was highly variable depending on the residue/gene involved, but roughly similar between the two genetic backgrounds. All but two(ERG11R398I, ERG3G111R) conferred fluconazole resistance, though the highest MIC increase was observed for MRR1G583R (≥650 fold). As expected in a diploid species, we noted an impact of allelic dosage. Some kind of cross-resistance to the other azoles was noted from some mutations, although the impact was lower for posaconazole and isavuconazole, except for MRR1G583R which led to multi-azole resistance. Finally, ERG3G111R increased tolerance to both azoles and echinocandins.

Impact of calmodulin inhibition by fluphenazine on susceptibility, biofilm formation and pathogenicity of caspofungin-resistant Candida glabrata

BACKGROUND

In recent decades, Candida glabrata has emerged as a frequent cause of life-threatening fungal infection. In C. glabrata, echinocandin resistance is associated with mutations in FKS1/FKS2 (β-1,3-glucan synthase). The calmodulin/calcineurin pathway is implicated in response to antifungal stress and calcineurin gene disruption specifically reverses Fks2-mediated resistance of clinical isolates.

OBJECTIVES

We evaluated the impact of calmodulin inhibition by fluphenazine in two caspofungin-resistant C. glabrata isolates.

METHODS

C. glabrata isolates were identified by ITS1/ITS4 (where ITS stands for internal transcribed spacer) sequencing and the echinocandin target FKS1/FKS2 genes were sequenced. Susceptibility testing of caspofungin in the presence of fluphenazine was performed by a modified CLSI microbroth dilution method. The effect of the fluphenazine/caspofungin combination on heat stress (37°C or 40°C), oxidative stress (0.2 and 0.4 mM menadione) and biofilm formation (polyurethane catheter) was analysed. A Galleria mellonella model using blastospores (1 × 109 cfu/mL) was developed to evaluate the impact of this combination on larval survival.

RESULTS

F659del was found in the FKS2 gene of both resistant strains. In these clinical isolates, fluphenazine increased susceptibility to caspofungin and reduced their thermotolerance. Furthermore, the fluphenazine/caspofungin combination significantly impaired biofilm formation in an in vitro polyurethane catheter model. All these features participated in the increasing survival of infected G. mellonella after combination treatment in comparison with caspofungin alone.

CONCLUSIONS

In a repurposing strategy, our findings confirm that calmodulin could provide a relevant target in life-threatening fungal infectious diseases.

Prevalence and nature of sexual violence in a gerontopsychiatric population in flanders

Introduction

Sexual violence (SV) is an important public health concern which may induce important and long lasting mental health problems. However, studies on SV and its mental health impact on older adults and more specifically gerontopsychiatric patients are currently lacking.

Objectives

This study aims to contribute to a better understanding of the prevalence, risk factors and mental health impact of SV in a gerontopsychiatric patient population.

Methods

Between July 2019 and March 2020 100 patients (66%F, 34%M) participated in a face to face interview on health, sexuality and wellbeing during their admission at an old age psychiatry ward in one general hospital and two psychiatric hospitals across Flanders, Belgium. Participation rate was 58%. Interviews were performed by a psychiatric trainee and especially trained master students in medicine.

Results

58% (65%F; 42%M) of the participants were sexually victimised during their life, 45% (51%F, 33%F) experienced hands-off SV, 43% (48%F, 33%M) sexual abuse with physical contact and 16% (6%M, 21%F) was raped. 7% were sexually victimised in the past year. Compared with non-victimized respondents, hands-on SV victims (incl. rape) described more symptoms of depression (p=0.007) and anxiety (p=0.003) and reported lower resilience (p=0.022).

Conclusions

SV appears to be common in the gerontopsychiatric population and is linked to even worse mental health outcomes. These findings confirm the long-lasting mental health impact of SV and highlight the importance of attention to (sexual) trauma in mental health care in old age.

Disclosure

No significant relationships.

[Shape and aesthetic outcome evaluation of transposed umbilicus according to four surgical procedures]

INTRODUCTION

In abdominal plastic surgery, umbilicus is frequently transposed, generating scars and shapes variating with the techniques used. Various umbilical transposition techniques have been described, all of them attempt to reproduce the "ideal" umbilicus. This study aimed to define the shape and the aesthetic results obtained with four different surgical procedures, in order to choose an "ideal" umbilical transposition technique.

PATIENTS AND METHODS

This retrospective study analyzed the characteristics of transposed umbilicus, in 50 patients who had undergone abdominal dermolipectomy for aesthetic reason, after a loss of weight or in breast reconstruction by Deep-Inferior-Epigastric-Perforator. Four surgical procedures were chosen, which differed by their counter-incision shape in the abdominal flap (Y, inverted Y, de-epidermized round with horizontal incision or U), and the deep points position of umbilical docking (along a horizontal or vertical axis). Shape and depth were evaluated by a panel of experts. The global assessment was based on a double evaluation, by the surgical jury and the patients themselves.

RESULTS

The counter-incision type determined the umbilicus shape: triangular for the Y (60%) or inverted-Y (41%), round for the U (52%) and vertical oval (67%) or round (32%) for the de-epidermized circle. The deep points position influenced the umbilicus axis. Regarding the appreciation, the de-epidermized circle had the best results for surgeons in a significant way, and for patients (respectively 72% and 100% satisfied), followed by the inverted-Y (57% and 92%) and Y techniques (55% and 89%) and at last the U (50 and 75%).

CONCLUSION

Horizontal counter incision in a de-epidermized round, with two anchoring points on a vertical axis, generates vertical oval or round shaped umbilicus, considered attractive in the literature, and giving the highest aesthetic satisfaction for both surgeons and patients.

New insights on molecular internalization and drug delivery following plasma jet exposures

In this study, we evaluated cold atmospheric plasmas as a physical drug delivery tool for human cervical cancer HeLa cells and murine breast carcinoma 4T1 cells. Different cell exposure protocols - plasma jet, plasma treated medium, and combinations of plasma-induced electric field and plasma treated medium- have been proposed and assessed to provide new insight on plasma-induced uptake mechanism. Cell culture medium composition and volume are key parameters to achieve an efficient molecular uptake. The plasma device enabled the delivery of molecules having 150 kDa-size into 4T1cells. For the first time to our knowledge, substance uptake kinetics after plasma treatment were investigated. The percentage of positive cells for propidium iodide and an anti-cancer agent, doxorubicin, was higher when the drugs were added a few minutes after treatment. The Plasma treated medium was not found to be as efficient as direct plasma treatment in 4T1 cells while allowing an efficient delivery in HeLa cells. Uptake levels as high as 39.3 ± 2.9% and 40.1 ± 9.5% for HeLa and 4 T1 cells respectively were achieved for optimized operating conditions, for which the viability of the cells was not severely affected. We also observed that plasma treatment induced the formation of actin stress fibers into cells revealing a mechanical stress.

The relational dimensions of pharmaceutical care: Experience from caring for HIV-infected asylum seekers in Montréal

By describing the experience from dispensing antiretroviral drugs to asylum seekers infected with HIV in Montreal we argue for the relational dimensions of pharmaceutical care. Between 2010 and 2016, the Government of Canada changed the medical coverage for refugees and asylum seekers, leading to some uncertainty about what types of care were reimbursable for each migrant status. In Quebec, despite the compensatory coverage provided by the provincial medical insurance board (Régie d'assurance maladie du Québec, or RAMQ), this uncertainty led to a breakdown in patient followup in some establishments. The McGill University Health Centre's Chronic Viral Illness Service (CVIS) was nevertheless able to maintain continuity of care for refugees and asylum seekers living with HIV. This article looks more specifically at the pharmaceutical care provided during this period and, more particularly, at the convergence of the technical and relational dimensions. The methodology used was a qualitative case study, which made it possible to explore pharmaceutical care, by conducting qualitative interviews (n = 16). Semistructured interviews were conducted with patients and various professionals from the CVIS, including pharmacists. The cultural, administrative, and political dimensions of pharmaceutical care described here appear very important for overall patient care. Further reflection on the importance of relational dimensions of pharmaceutical care and the place and value of pharmaceutical care in the advancement of patient care is required.

Precise genome editing using a CRISPR-Cas9 method highlights the role of CoERG11 amino acid substitutions in azole resistance in Candida orthopsilosis

Background

Azoles are one of the main antifungal classes for the treatment of candidiasis. In the current context of emerging drug resistance, most studies have focused on Candida albicans, Candida glabrata or Candida auris but, so far, less is known about the underlying mechanisms of resistance in other species, including Candida orthopsilosis.

Objectives

We investigated azole resistance in a C. orthopsilosis clinical isolate recovered from a patient with haematological malignancy receiving fluconazole prophylaxis.

Methods

Antifungal susceptibility to fluconazole was determined in vitro (CLSI M27-A3) and in vivo (in a Galleria mellonella model of invasive candidiasis). The CoERG11 gene was then sequenced and amino acid substitutions identified were mapped on the predicted 3D structure of CoErg11p. A clustered regularly interspaced short palindromic repeat-Cas9 (CRISPR-Cas9) genome-editing strategy was used to introduce relevant mutations into a fluconazole-susceptible C. orthopsilosis isolate.

Results

Compared with unrelated C. orthopsilosis isolates, the clinical isolate exhibited both in vitro and in vivo fluconazole resistance. Sequencing of the CoERG11 gene identified several amino acid substitutions, including two possibly involved in fluconazole resistance (L376I and G458S). Both mutations mapped close to the active site of CoErg11p. Engineering these mutations in a different genetic background using CRISPR-Cas9 demonstrated that G458S, but not L376I, confers resistance to fluconazole and voriconazole.

Conclusions

Our data show that the G458S amino acid substitution in CoERG11p, but not L376I, contributes to azole resistance in C. orthopsilosis. In addition to highlighting the potential of CRISPR-Cas9 technology for precise genome editing in the field of antifungal resistance, we discuss some points that are critical to improving its efficiency.

[Back loss cover in orthopedic surgery by helical lumbar perforator flaps: About 6 cases]

INTRODUCTION

The existence of voluminous paralumbar perforators allows a simplification of the coverage of the lumbar region.

MATERIALS AND METHODS

The authors present a series about lumbar loss substance following orthopedic surgery, from 2012 to 2017. Coverage was provided by a fascio-cutaneous lumbar perforator flap.

RESULTS

Six patients were operated with mean age of 62.3 years, with an average follow-up of 16 months (up 6 to 41 months). Substance losses were secondary to a carcinologic excision, to a radiodermitis excision and to four debridements after infection of the operative site. In five cases, the reconstruction was performed by one lumbar perforator flap, and in one case by two lumbar perforator flaps. The average size of the substance losses was 171.91 cm² (up 78 to 250 cm²). The average size of the flaps taken was 161 cm² (up 50 to 250 cm²). The donor site was self-closing without sequelae. The postoperative sequences were simple and marked by a single partial necrosis of a flap, with a favorable evolution after directed healing. The quality of the cover was good with excellent trophicity.

CONCLUSION

Lumbar perforator helical fascio-cutaneous flaps are a reliable means of covering the loss of substances in the lumbar region. The use of these flaps makes it possible to avoid the taking of complex myo-cutaneous flaps, causing sequelae of the donor site in a location difficult to cover.

[Trochanteric under gluteus lift or bodylift, technique for massive trochanteric lipodystrophy: About 11 cases]

INTRODUCTION

There is a growing demand for weight loss sequelae. Some women have a particular morphology with a major trochanteric excess that warrants specific treatment.

MATERIALS AND METHODS

On the basis of the technique published in 1964 by Pitanguy, the authors suggest a lift of the external face of the thigh with the scar redrawing the lower part of the buttock, from the gluteal fold to the inguinal region by crossing the trochanteric region. Eleven cases of major trochanteric excess after slimming are presented. In 4 cases, the trochanteric excess is solely treated by trochanteric under gluteus lift. In 7 cases, it is associated with abdominoplasty to perform a trochanteric under gluteus bodylifting.

RESULTS

Complications and results are presented. The trochanterian excess is reduced, the buttock is harmonious and the patients satisfied.

DISCUSSION

Modifications are made to the much criticized technique of Pitanguy. The lipectomy replaces the monobloc resection, the scar is verticalized on the trochanter to join the abdominoplasty scar. This technique is an alternative to the vertical trochanteric resection associated with classic bodylift.

CONCLUSION

The trochanteric under gluteus lift is an elegant solution for treating large trochanteric excess. It is adaptable. It can become bodylifting TSF in the cases of great slimming.

Non-surgical treatments for hidradenitis suppurativa: A systematic review

INTRODUCTION

The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures.

METHODS

This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline^®, PubMed Central, Embase and Cochrane databases published between January 2005 and September 2015.

RESULTS

Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates.

CONCLUSIONS

None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which is the only treatment allowing hope for cure.

CAPN1 gene as a potential marker for growth performance and carcass characteristics in pigs

The calcium-activated neutral proteinase 1 (CAPN1) gene, which encodes µ-calpain, is considered to be associated with the majority of meat-quality traits. The objective of the present study was to evaluate the effect of CAPN1 polymorphism on the most important slaughter, fattening and pork-quality traits. The genotype frequency of g.1429G>A polymorphism was estimated on 860 pigs represented by five breeds (Polish Landrace, Polish Large White, Pietrain, Duroc and Pulawska). In all breeds, the most frequent were pigs with an AA genotype (60–74%), with the exception of Duroc pigs where the largest number of GG animals was observed (14%). The results showed that g.1429G>A polymorphism significantly affected the number of days on test (P ≤ 0.05) and age at slaughter (P ≤ 0.01), the weight of ham and primary cuts (P ≤ 0.05, P ≤ 0.01 respectively), loin eye area (P ≤ 0.01) and average backfat thickness (P ≤ 0.05). The g.1429G>A single-nucleotide polymorphism showed no clear influence on complex pork-quality traits. At the present stage of research, the results obtained allow for the use of g.1429G>A polymorphism in CAPN1 gene as genetic marker in pig selection to improve several slaughter or fattening traits.

First in-flight synchrotron X-ray absorption and photoemission study of carbon soot nanoparticles

Many studies have been conducted on the environmental impacts of combustion generated aerosols. Due to their complex composition and morphology, their chemical reactivity is not well understood and new developments of analysis methods are needed. We report the first demonstration of in-flight X-ray based characterizations of freshly emitted soot particles, which is of paramount importance for understanding the role of one of the main anthropogenic particulate contributors to global climate change. Soot particles, produced by a burner for several air-to-fuel ratios, were injected through an aerodynamic lens, focusing them to a region where they interacted with synchrotron radiation. X-ray photoelectron spectroscopy and carbon K-edge near-edge X-ray absorption spectroscopy were performed and compared to those obtained for supported samples. A good agreement is found between these samples, although slight oxidation is observed for supported samples. Our experiments demonstrate that NEXAFS characterization of supported samples provides relevant information on soot composition, with limited effects of contamination or ageing under ambient storage conditions. The highly surface sensitive XPS experiments of airborne soot indicate that the oxidation is different at the surface as compared to the bulk probed by NEXAFS. We also report changes in soot's work function obtained at different combustion conditions.

The amino acid substitution N136Y in Candida albicans sterol 14alpha-demethylase is involved in fluconazole resistance

Resistance to fluconazole antifungal is an ongoing impediment to a successful treatment of Candida albicans infections. One of the most prevalent mechanisms leading to azole resistance is genetic alterations of the 14α-demethylase, the target of azole antifungals, through point mutations. Site-directed mutagenesis and molecular modeling of 14α-demethylase rationalize biological data about the role of protein substitutions in the azole treatment failure. In this work, we investigated the role of N136Y substitution by site-directed mutagenesis into Pichia pastoris guided by structural analysis. Single amino acid substitutions were created by site-directed mutagenesis into P. pastoris with C. albicans ERG11 gene as template. In vitro susceptibility of P. pastoris transformants expressing wild-type and mutants to azole compounds was determined by CLSI M27-A2 and spot agar methods. The fluconazole effect on ergosterol biosynthesis was analyzed by gas chromatography-mass spectrometry. By microdilution and spot tests, N136Y transformants showed a reduced in vitro susceptibility to fluconazole compared to wild-type controls. As expected, ergosterol/lanosterol ratios were higher in N136Y transformants compared to the wild-type controls after treatment with fluconazole. Molecular modeling suggests that residue Asn136 located within the first mutation hot spot, could play a role during heme and azole binding. These results provide new insights into the structural basis for 14α-demethylase-azole interaction and could guide the design of novel azole antifungals.

Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests

BACKGROUND

Awake craniotomy is currently considered the gold standard to maximise the extent of resection and to minimise postoperative deficits in patients with supratentorial tumours near eloquent areas. In addition to direct electrical stimulation (DES) of the cortex, intraoperative subcortical mapping is increasingly used as it optimises the benefit-to-risk ratio by decreasing (permanent) postoperative neurological deficits. However, only little attention has been paid to subcortical mapping procedures and especially the tasks to be used.

METHODS

In this article, language and non-language testing at the subcortical level is described and discussed by means of three right-handed cases with a glioma in the left hemisphere. To assess subcortical functions, a multimodal test named the Quick Mixed Test was developed (QMT). Pre-, intra- and postoperative test results are described and discussed in detail.

RESULTS

Based on the analysis of these preliminary observations, a number of clinical recommendations for intraoperative subcortical mapping may be made: (1) the selection of a set of language and non-language tests needs to be tailored according to the functional corticosubcortical regions affected by the tumoral lesion and the patient's characteristics (job/hobby/daily life activities); (2) language and non-language tests should be presented in a multimodal and alternating way during subcortical stimulation since this approach enables screening various functions simultaneously or in a very short period of time and (3) spontaneous speech is a useful adjunct to standardised tests since it most resembles daily life conversation.

CONCLUSION

Administration of multimodal tests during subcortical DES such as the experimental QMT may facilitate identification of eloquent pathways leading to avoidance of permanent neurological impairments.

[Determinants of breastfeeding in the Brussels Region]

PURPOSE

The objectives of this paper is to study the prevalence of breastfeeding in Brussels, to assess whether the targets of the Maternal and Child Health program (MCH) were met (prevalence's of breastfeeding of 85 and 75% of exclusive breastfeeding) and finally to identify factors associated with exclusive breastfeeding at the birth.

MATERIALS AND METHOD

The cross-sectional survey is representative of children 18 to 24 months living in Brussels. Data on breastfeeding are anamnestic and retrospective. A face to face questionnaire was administered by trained investigators, 16 questions about breastfeeding as well socio-demographic information were collected from 544 mothers. The survey took place in 2012.

RESULTS

At the birth, 83.3% (95% CI 80.1-86.4) of mothers exclusively breastfed and 9.7% of the mothers (7.3-12.2) partially. When discharged from maternity unit, 80.9% (77.6-84.2) of mothers breastfed exclusively and 9.7% (7.3-12.2) partially. When fitting a logistic model, predictors associated with exclusive breastfeeding at the birth were gestation, type of birth, father's education level and the main influencing factor was the partner's attitude.

DISCUSSION

The targets of the MCH were reached in Brussels. Until now, transversal surveys are the only way of knowing the prevalence and the factors associated with breastfeeding in Brussels. These first representative data on breastfeeding came from the 2012 vaccine coverage survey. Given the primary role of the father in choosing a breastfeeding it is necessary that the father is more often taken into account in regard to the promotion of AM during the prenatal period. A rigorous use of definitions of AM should be systematized.

The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery

Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located.

Structural and Dynamic Approaches of Molten Salts by High Temperature Spectroscopies

The combination of 27AI NMR expriments and Molecular Dynamics simulation confirms the exis-tence of penta-coordinated Aluminium in several molten aluminium oxides. In the case of fluoroalumi-nate molten salts, NMR and Raman spectroscopies provide complementary approaches leading to a structural description in term of AIF− 4, AlF5 2-and AlF6 3−species.

[Breastfeeding in the French-speaking community of Belgium (2009)]

PURPOSE

The objectives of this paper were to study the prevalence of breastfeeding in the French-speaking community of Belgium, to assess whether the targets of the Maternal and Child Health program (MCH) were met (prevalence of breastfeeding of 85, 70, 50, and 25% at the maternity hospital and at 3, 6, and 12 months of age, respectively), and to identify factors associated with breastfeeding at the maternity hospital and at 6 months of age.

MATERIALS AND METHODS

A sample (two-stage cluster sampling) was drawn from the population of children aged 18-24 months living in the area. A face-to-face questionnaire was administered by trained investigators. Anamnestic data on breastfeeding at the maternity hospital and at 3, 6, and 12 months as well sociodemographic information were collected from 522 mothers. The survey took place in 2009.

RESULTS

At the maternity hospital, 75.7% (95%CI [72.7-79.5]) of the mothers were breastfeeding: 72.4% among the Belgians (and French) and 89.0% among foreign mothers. At 3 months of age, the breastfeeding prevalence was 48.3% (CI, 44.0-52.6): 42.5% among the Belgians (and French) and 72.0% among foreign mothers (p<0.001). At 6 months of age, 26.0% of the mothers were breastfeeding (CI, 22.3-29.8): 19.3% among the Belgians (and French) and 53.0% among foreign mothers (p<0.001). At 12 months of age, 10.0% (CI, 7.4-12.5) of the mothers were breastfeeding: 4.8% among the Belgians (and French) and 31.0% among the foreign mothers (p<0.001). When fitting a logistic model, the predictors associated with breastfeeding at the maternity hospital were educational level, nationality of birth, and parity. At 6 months, logistic models were fitted separately in the two strata. Among the Belgians, the level of education and attending a MCH consultation were significantly associated with breastfeeding. In the stratum of foreign mothers, the only factor associated with breastfeeding was working time. No association was observed between breastfeeding and the mother's age at the maternity hospital or at 6 months.

DISCUSSION

The targets of the MCH were not reached in Belgian and French mothers, while they were in mothers of other nationalities. Until now, transversal surveys have been the only way of knowing the prevalence and the factors associated with breastfeeding in the French-speaking community of Belgium. These first representative data on breastfeeding came from the 2009 vaccine coverage survey.

Deep inner-shell multiphoton ionization by intense x-ray free-electron laser pulses

We have investigated multiphoton multiple ionization dynamics of xenon atoms using a new x-ray free-electron laser facility, SPring-8 Angstrom Compact free electron LAser (SACLA) in Japan, and identified that Xe(n+) with n up to 26 is produced at a photon energy of 5.5 keV. The observed high charge states (n≥24) are produced via five-photon absorption, evidencing the occurrence of multiphoton absorption involving deep inner shells. A newly developed theoretical model, which shows good agreement with the experiment, elucidates the complex pathways of sequential electronic decay cascades accessible in heavy atoms. The present study of heavy-atom ionization dynamics in high-intensity hard-x-ray pulses makes a step forward towards molecular structure determination with x-ray free-electron lasers.

Malformation surveillance and maternal drug exposure: the MADRE project

A project implemented within the framework of the International Clearinghouse for Birth Defect Monitoring Systems is named MADRE: MAlformation DRug Exposure surveillance. The idea is to survey the simultaneous occurrence of malformations and first-trimester drug exposures. In a 2-year period 1990-91, this has yielded 1448 infants known to have been exposed to drugs and that are known to have malformations. Cases have been reported by eight programs: Australia, Central-East France, Israel, Italy IPIMC, Italy IMER, Japan Red Cross Hospitals, Japan Maternal Health and Welfare, and South America. By searching this databank for associations between drugs and malformations, specific relationships can be detected.The 9th revision of the WHO International Classification of Diseases, adapted by the British Paediatric Association, known as ICD9/BPA is used for coding malformations. This is a hierarchical system with 5 digits as the maximum level of specification of each malformation.The ATC (Anatomical Therapeutic Chemical) classifications system is used for coding drugs. This is a multiple level, hierarchical classification with up to 7 digits for specifying each drug.Up to five drugs and malformations are coded for each case using ATC and ICD9/BPA classifications, and all observed drug-malformation pairs form the basis for the analysis. For each drug-malformation combination where three or more cases are observed, a set of 2×2 tables is formed and analyzed as in case-control studies. The odds ratio for the pair, stratified for program, gives the relative risk for the malformation in question, comparing use of the specific drug with all other drugs.Well known or controversial associations were tested in the collected material, and at this stage only one new association is suggested, that is between cardiac defects and maternal treatment with thyroid hormones. This finding has to be further explored with new data.

Hormone therapy during pregnancy and isolated hypospadias: an international case-control study

Mothers of boys with hypospadias and control mothers were interviewed in eight malformation monitoring programs around the world. Hormone therapy was used quite frequently in five but rarely in three of the programs. The odds ratio for hypospadias after hormone therapy during pregnancy was 2.8 (95% confidence limits 1.2, 6.9) but there was no correlation between the timing of hormone therapy and the location of the urethral orifice, nor between the severity of the malformation and hormone therapy. Programs with the highest hormone exposure rate showed the lowest odds ratio for pregnancy bleeding, the most common reason for hormone therapy. These latter findings cast doubts on the causal association between hormone therapy and isolated hypospadias. Alternative explanations are recall or interviewer bias or unidentified confounders.

Spectrin-like repeats 11-15 of human dystrophin show adaptations to a lipidic environment

Dystrophin is essential to skeletal muscle function and confers resistance to the sarcolemma by interacting with cytoskeleton and membrane. In the present work, we characterized the behavior of dystrophin 11-15 (DYS R11-15), five spectrin-like repeats from the central domain of human dystrophin, with lipids. DYS R11-15 displays an amphiphilic character at the liquid/air interface while maintaining its secondary α-helical structure. The interaction of DYS R11-15 with small unilamellar vesicles (SUVs) depends on the lipid nature, which is not the case with large unilamellar vesicles (LUVs). In addition, switching from anionic SUVs to anionic LUVs suggests the lipid packing as a crucial factor for the interaction of protein and lipid. The monolayer model and the modulation of surface pressure aim to mimic the muscle at work (i.e. dynamic changes of muscle membrane during contraction and relaxation) (high and low surface pressure). Strikingly, the lateral pressure modifies the protein organization. Increasing the lateral pressure leads the proteins to be organized in a regular network. Nevertheless, a different protein conformation after its binding to monolayer is revealed by trypsin proteolysis. Label-free quantification by nano-LC/MS/MS allowed identification of the helices in repeats 12 and 13 involved in the interaction with anionic SUVs. These results, combined with our previous studies, indicate that DYS R11-15 constitutes the only part of dystrophin that interacts with anionic as well as zwitterionic lipids and adapts its interaction and organization depending on lipid packing and lipid nature. We provide strong experimental evidence for a physiological role of the central domain of dystrophin in sarcolemma scaffolding through modulation of lipid-protein interactions.

[Pyeloplasty for pyelo-ureteric junction syndrome in children: lombo-assisted procedure versus lombotomy]

Surgical treatment of pyelo-ureteric junction syndromes was classically at the child's, a pyeloplasty by posterior way or by lombotomy. For several years, assisted video techniques are proposed for this gesture. The purpose of our study was to compare the lombo-assisted pyeloplasty procedure with the lombotomy procedure, within the framework of this coverage. We made a retrospective study of procedures performed from January 2000 to December 2005, based on a file review of children operated for pyelo-ureteric junction syndrome. Children under the age of 2 years were excluded. Fifty-two children were divided in 2 groups: group 1: 24 children, 7 girls and 17 boys, average age of 86 months (extremes: 27-172) benefited from a lombo-assisted pyeloplasty. Group 2: 28 children, 12 girls and 16 boys, average age of 69 months (extremes: 24-129) benefited from a pyeloplasty by lombotomy. Operating times were significantly shorter in opened surgery than with the lombo-assisted procedure. There was no significant difference in terms of per- or post-operating complication, use of analgesic and hospitalization duration. On the other hand, the lombo-assisted procedure provided the same undisputable aesthetic benefit and the same muscular preservation than pure lomboscopy procedure. As a consequence, this procedure could be set up at no risk for the patient, even if it had lead to longer operating times. However, operating times stayed shorter than with the pure lomboscopy or the celioscopy procedures, compared to the literature.

Quantitative real-time PCR primer design, cDNA amplification and sequence analysis from 22 genes mainly associated with lipid metabolism in Pekin (Anas platyrhynchos) and Muscovy (Cairina moschata) ducks

Few genomic tools are available in ducks. To produce some new resources, we have designed Pekin (Anas platyrhynchos) and Muscovy (Cairina moschata) duck-specific primers for 22 genes involved mainly in lipid metabolism, and to a lesser extent in carbohydrate metabolism and other functions. Primers were designed according to duck sequences when available and otherwise from the corresponding conserved regions in chicken and human sequences. These primers allowed quantitative RT-PCR amplification of RNA from Pekin and Muscovy ducks. Amplified cDNA products from both species were sequenced and were found to be very similar to chicken sequences (about 94%). This work provides additional genomic resources and polymorphism information for some genes in duck species and represents a first step towards gene expression analyses in Pekin and Muscovy ducks.

Is trisomy 18 increasing in Sweden? An analysis of the syndrome during a ten year period and a comparison with a French registry

This paper reports an analysis of trisomy 18 in Sweden between 1978 and 1987 and a comparison with data from the Rhône-Alpes/Auvergne registry in France. A strong maternal age dependency is seen, which parallels that observed for Down syndrome. The patterns of registered malformations in the two data sets are quite similar. A progressive increase of the prevalence at birth of trisomy 18 is seen in Sweden during the ten years but not in France. This increase seems to result, at least in part, from an increased identification of the trisomy among malformed infants. A parallel decrease in the reporting of infants with the "cardinal" trisomy 18 malformations is indicated.