Lactobacillus rhamnosus GG ameliorates hyperuricemia in a novel model

Hyperuricemia (HUA) is a metabolic syndrome caused by abnormal purine metabolism. Although recent studies have noted a relationship between the gut microbiota and gout, whether the microbiota could ameliorate HUA-associated systemic purine metabolism remains unclear. In this study, we constructed a novel model of HUA in geese and investigated the mechanism by which Lactobacillus rhamnosus GG (LGG) could have beneficial effects on HUA. The administration of antibiotics and fecal microbiota transplantation (FMT) experiments were used in this HUA goose model. The effects of LGG and its metabolites on HUA were evaluated in vivo and in vitro. Heterogeneous expression and gene knockout of LGG revealed the mechanism of LGG. Multi-omics analysis revealed that the Lactobacillus genus is associated with changes in purine metabolism in HUA. This study showed that LGG and its metabolites could alleviate HUA through the gut-liver-kidney axis. Whole-genome analysis, heterogeneous expression, and gene knockout of LGG enzymes ABC-type multidrug transport system (ABCT), inosine-uridine nucleoside N-ribohydrolase (iunH), and xanthine permease (pbuX) demonstrated the function of nucleoside degradation in LGG. Multi-omics and a correlation analysis in HUA patients and this goose model revealed that a serum proline deficiency, as well as changes in Collinsella and Lactobacillus, may be associated with the occurrence of HUA. Our findings demonstrated the potential of a goose model of diet-induced HUA, and LGG and proline could be promising therapies for HUA.

Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK

BACKGROUND

Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus.

AIM

To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe.

METHODS

The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls.

FINDINGS

In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis.

CONCLUSION

The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Evaluation of sleep and therapeutic education needs of military with PTSD

Sleep disorders in post-traumatic stress disorder (PTSD) are both diagnostic (nocturnal reliving) and prognostic. Poor sleep worsens the daytime symptomatology of PTSD and makes it resistant to treatment. However, no specific treatment is codified in France to treat these sleep disorders although sleep therapies (cognitive behavioural therapy for insomnia, psychoeducation and relaxation) have proven for years to be effective in treating insomnia. Therapeutic sessions can be part of a therapeutic patient education program, which is a model for the management of chronic pathologies. It allows for an improvement in a patient's quality of life and enhanced medication compliance. We therefore carried out an inventory of sleep disorders of patients with PTSD. First, we collected data by means of sleep diaries concerning the population's sleep disorders at home. Then we assessed the population's expectations and needs regarding its management of sleep, thanks to a semi-qualitative interview. The data from sleep diaries, which was consistent with the literature, showed that our patients suffered from severe sleep disorders that strongly impact their daily lives, with 87% of patients having an increased sleep onset latency, and 88% having nightmares. We observed a strong demand from patients for specific support for these symptoms, 91% expressing an interest in a TPE program targeting sleep disorders. Thanks to the data collected, the emerging themes for a future therapeutic patient education program targeting sleep disorders of soldiers with PTSD are: sleep hygiene; management of nocturnal awakenings, including nightmares; and psychotropic drugs.

Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)]

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Protein signatures of spontaneous lipolysis and lipoprotein lipase activity in cow's milk

Spontaneous milk lipolysis refers to the breakdown of triacylglycerols in milk. Lipolysis impacts the organoleptic value of milk by causing off-flavours and reduces the technological properties of milk. Lipolysis is caused by lipoprotein lipase (LPL), a tightly regulated enzyme in milk. Our objective was to identify robust biomarkers of lipolysis and putative regulators of LPL enzyme in bovine milk. To achieve this goal, we used feed restriction as a lever to generate highly contrasted samples with regard to milk lipolysis. We combined statistical methods on proteomics data, milk lipolysis and LPL activity values. Following this strategy, we identified CD5L and GP2 as robust biomarkers of high lipolysis in cow milk. We also identified HID1, SURF4 and CUL9 as putative inhibitors of the lipolytic process in the milk. We thus proposed 5 putative biomarkers to be considered in future tools to manage milk lipolysis. SIGNIFICANCE: This manuscript is notable in three aspects. First, this is the first evaluation of the milk proteome relative to milk lipolysis or LPL activity. Second, the relationship between the abundance of proteins and milk traits was evaluated by a combination of univariate and multivariate analyses. Third, we provide a short list of five proteins to be tested in a larger population to feed the pipeline of biomarker discovery.

2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults

These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.

[State of the art on the pathophysiology, diagnosis and treatment of non-alcoholic steatohepatitis (NASH)]

NAFLD or non-alcoholic fatty liver disease is one of the complications of obesity and diabetes, the prevalence of which is increasing. The causes of the pathology and its development towards its severe form, NASH or non-alcoholic steatohepatitis, are multiple and still poorly understood. Many different pharmacological classes are being tested in clinical trials to treat NASH, but no pharmaceutical treatment is currently on the market. Moreover, the diagnosis of certainty is only possible by liver biopsy and histological analysis, an invasive procedure with high risk for the patient. It is therefore necessary to better understand the natural history of the disease in order to identify therapeutic targets, but also to identify markers for the diagnosis and monitoring of the disease using a blood sample, which will allow an improvement in patient management.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande

We report a search for cosmic-ray boosted dark matter with protons using the 0.37  megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1  MeV/c^{2} to 300  MeV/c^{2}.

STEREO neutrino spectrum of 235U fission rejects sterile neutrino hypothesis

Anomalies in past neutrino measurements have led to the discovery that these particles have non-zero mass and oscillate between their three flavours when they propagate. In the 2010s, similar anomalies observed in the antineutrino spectra emitted by nuclear reactors have triggered the hypothesis of the existence of a supplementary neutrino state that would be sterile, that is, not interacting by means of the weak interaction1. The STEREO experiment2-6 was designed to investigate this conjecture, which would potentially extend the standard model of particle physics. Here we present an analysis of the full set of data generated by STEREO, confirming observed anomalies while rejecting the hypothesis of a light sterile neutrino. Installed at the Institut Laue-Langevin (ILL) research reactor, STEREO accurately measures the antineutrino energy spectrum associated to the fission of 235U. The segmentation of the detector and its very short distance to the compact core are crucial properties of STEREO for our analysis. The measured antineutrino energy spectrum suggests that anomalies originate from biases in the nuclear experimental data used for the predictions7,8. Our result supports the neutrino content of the standard model and establishes a new reference for the 235U antineutrino energy spectrum. We anticipate that this result will allow progress towards finer tests of the fundamental properties of neutrinos but also to benchmark models and nuclear data of interest for reactor physics9,10 and for observations of astrophysical or geoneutrinos11,12.

Milk fat depression and plasma lipids in dairy cows and goats

This study examines the effects of diets supplemented with various lipids selected to induce divergent milk fat content responses (including a milk fat depression) between dairy cows and goats on plasma lipid composition. The objective was to better understand the mechanisms behind the regulation of milk fat secretion in these two ruminant species. Twelve Holstein cows and 12 Alpine goats were fed a basal diet not supplemented (CTL) or supplemented with corn oil plus wheat starch (COS, 5% DM intake (DMI)), marine algae powder of Schizochytrium sp. (MAP, 1.5% DMI), or hydrogenated palm oil (HPO, 3% DMI), in a replicated 4 × 4 Latin square design, during 28 days. On day 27, blood samples were collected for lipid analysis. Plasma lipid classes were quantified by high-performance thin-layer chromatography, with triacylglycerol (TAG) and free fatty acid (FFA) fractions analysed for FA composition by GLC. Plasma molecular species of TAG and ceramides were determined by HPLC-high-resolution MS and by liquid chromatography-triple quadrupole, respectively. Irrespective of diet, plasma total lipid content was higher in cows than goats (+61%), and TAG concentration was higher in goats than cows (+157%). In cows, conversely to goats, COS increased the trans-10 C18:1 proportion in the free FA (+248%) and the TAG (+195%) fractions. In cows and goats, MAP induced increases in cholesterol esters, cholesterol and phospholipids compared to CTL and changes in the plasma free FA and FA of TAG profiles. In both ruminant species, the concentrations of the lipid fractions were unchanged by HPO compared to CTL. Our results point to species specificities and different diet effects in plasma concentrations and compositions of lipid fractions in cows and goats. These new data highlight how diets, that induce large variations in milk fat secretions, affect the plasma lipid classes available for milk fat synthesis.

Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins

BACKGROUND: Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. METHODS: In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. RESULTS: MCMA infants had a significantly lower compliance (0.64 vs 1.25 mL/cm H2O /kg; p = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2O /mL/sec; p = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4 mL/kg; p = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. CONCLUSIONS: Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship.

Feeding of palm oil fatty acids or rapeseed oil throughout lactation: Effects on mammary gene expression and milk production in Norwegian dairy goats

Lipid added as rapeseed or palm oil to the diet of dairy goats over 8 mo of one lactation alters fat secretion and milk fatty acid (FA) and protein composition. In this study, we examined the contribution of mammary gene expression to these changes and included 30 multiparous goats of Norwegian dairy goat breed for a 230-d experimental period, with indoor feeding from 1 to 120 d in milk (DIM), mountain grazing from 120 to 200 DIM, and indoor feeding from 200 to 230 DIM. After an initial period (1-60 DIM) when the control diet was given to all goats, the animals were subdivided into 3 groups of 10 goats. Treatments (60-230 DIM) were basal concentrate (control) alone or supplemented with either 8% (by weight) hydrogenated palm oil enriched with palmitic acid (POFA) or 8% (by weight) rapeseed oil (RSO). Milk was sampled individually from all animals throughout lactation, at 60, 120, 190, and 230 DIM for milk yield and composition. On d 60, 120, 190, and 230, mammary tissue was collected by biopsy to measure mRNA abundance of 19 key genes. None of the 19 genes involved in milk protein, apoptosis, lipid metabolism, transcription factors, and protein of the milk fat globule membrane, as measured by mRNA abundance, were affected by the lipid supplements, although POFA increased milk fat content, and POFA and RSO affected milk FA composition. Over the experimental period (120-230 DIM), the mRNA abundance of 13 of the 19 studied genes was affected by lactation stage. For some genes, expression either gradually increased from 120 to 230 DIM (CSN2,CASP8,CD36,GLUT4) or increased from 120 to 200 and then remained stable (XDH), or decreased (CSN3,G6PD,SREBF1,PPARG1) or increased only at 230 DIM (SCD1,SCD5,ELF3). For a second group of genes (CSN1, LALBA, FABP3, FASN, LPL, MFGE8), expression was stable over the lactation period. Our results suggest that factors other than gene expression, such as substrate availability or posttranscriptional regulation of these genes, could play an important role in the milk fat and FA responses to dietary fat composition in the goat. In conclusion, mammary gene expression in goats was more regulated by stage of lactation than by the dietary treatments applied.

[Survey on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]

Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits.

METHOD

ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017.

RESULTS

220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P<0.001). Patient wishes were noted by 30 (46.96%) only GP.

CONCLUSION

Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.

Joint Measurement of the ^{235}U Antineutrino Spectrum by PROSPECT and STEREO

The PROSPECT and STEREO collaborations present a combined measurement of the pure ^{235}U antineutrino spectrum, without site specific corrections or detector-dependent effects. The spectral measurements of the two highest precision experiments at research reactors are found to be compatible with χ^{2}/ndf=24.1/21, allowing a joint unfolding of the prompt energy measurements into antineutrino energy. This ν[over ¯]_{e} energy spectrum is provided to the community, and an excess of events relative to the Huber model is found in the 5-6 MeV region. When a Gaussian bump is fitted to the excess, the data-model χ^{2} value is improved, corresponding to a 2.4σ significance.

Searching for Hidden Neutrons with a Reactor Neutrino Experiment: Constraints from the STEREO Experiment

Different extensions of the standard model of particle physics, such as braneworld or mirror matter models, predict the existence of a neutron sterile state, possibly as a dark matter candidate. This Letter reports a new experimental constraint on the probability p for neutron conversion into a hidden neutron, set by the STEREO experiment at the high flux reactor of the Institut Laue-Langevin. The limit is p<3.1×10^{-11} at 95% C.L. improving the previous limit by a factor of 13. This result demonstrates that short-baseline neutrino experiments can be used as competitive passing-through-walls neutron experiments to search for hidden neutrons.

Automated contouring of non-contrast echocardiograms result in similar estimates of left ventricular function to manually contoured contrast-enhanced images in chemotherapy patients

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Ultromics Ltd

Introduction

Transthoracic echocardiography (TTE) assessment of left ventricular (LV) function has a central role in early detection and treatment of cancer-therapy related cardiac dysfunction (CTRCD). Contrast TTE is recommended to aid accurate and reproducible LV contouring , but contrast agents are underused and high variability remains. Using machine learning (ML) to automatically contour the LV reduces variability, and may provide comparable clinical benefit to contrast-enhanced TTE.

Purpose

Retrospective single site study evaluating agreement between LV volumes and function from manually contoured contrast-enhanced TTE and automated contouring of non-contrast enhanced images.

Methods

Adults at risk of developing CTRCD who underwent TTE were recruited. LV volumes (end-diastolic and systolic; EDV and ESV, respectively) and function (ejection fraction; EF) were measured from contrast-enhanced images using manual contouring (MAN-CONT), and non-contrast enhanced images using automation (AUTO-NON). Method comparisons were summarised based on: (i) statistical equivalence (two one-sided t-tests), (ii) systematic difference between methods, via root mean-squared error (RMSE; Deming regression), and (iii) average bias (Bland-Altman). Statistical equivalence bounds were conservatively determined from reproducibility estimates in a similar cohort (EDV, 20 mL; ESV, 15 mL; EF, 5%; REF1), and used to interpret RMSE and bias.

Results

The cohort comprised of patients undergoing treatment for breast cancer, lymphoma, and myeloma. Similar body mass indices were seen between groups (median [IQR]: 26.5 [6.7] kg/m2; Kruskall-Wallace test, p = 0.320), but breast cancer patients were younger (55.0 [14.5], 58.5 [23], 60 [9], respectively; p = 0.034). For estimates of LV volumes and function, statistical equivalence, RMSE, and bias are presented in Table1. Average estimates (mean [SD]) of EDV, ESV, and EF were 121 [33] vs. 112 [33] mL, 50 [23] vs. 44 [19] mL, and 60 [9] vs. 61 [8]%, for MAN-CON and AUTO-NON respectively. Comparing between MAN-CON and AUTO-NON in breast cancer patients, all variables were statistically equivalent (Figure1), and while bias was lower than equivalence bounds, RMSE was only lower for EDV and ESV, not EF. For lymphoma patients, estimates of EDV were statistically equivalent, but not EF and ESV. Bias was lower than equivalence bounds for all variables, whereas RMSE was lower for ESV, but not EDV or EF. For myeloma patients, estimates of ESV and EF were statistically equivalent, but not EDV. While bias was lower than equivalence bounds for all variables, RMSE was not lower for any variable. Conclusions: Estimates of LV function from automated contouring of non-contrast TTE are similar to contrast-enhanced TTE (manually contoured), despite poorer image quality. Automated contouring using ML reduces variability, therefore increasing TTE sensitivity, which is critical when clinical management relies on accurate assessment of LV function. Abstract Table1  Abstract Figure1

Management of COVID-19 in a French Nursing Home: Experiences from a Multidisciplinary Mobile Team

Background

Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur.

Method

In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists.

Results

On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs’ main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management.

Conclusion

Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit disease transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees, and (iii) provide sufficient human resources.

Effect of concentrate enriched with palmitic acid versus rapeseed oil on dairy performance, milk fatty acid composition, and mammary lipogenic gene expression in mid-lactation Holstein cows

This study was performed to characterize the effect of a concentrate supplemented with free palmitic acid (4% on a DM basis; PA) or rapeseed oil (4% on a DM basis; RO) compared with a no-added-lipid control concentrate (CT) on the performance of dairy cows fed a corn silage-based diet over a 9-wk period. After a 3-wk pre-experimental period, 54 Holstein cows were randomly allocated to 3 experimental treatments to receive forage ad libitum with a fixed amount of CT, RO, or PA (8 kg/d for 2-yr-old primiparous; 10 kg/d for older cows). During the experiment, dry matter intake, milk yield and composition, fatty acid (FA) yields and FA profile, and feed efficiency were determined. At wk 9 of the experimental period, the mRNA levels of 10 genes involved in lipid metabolism in mammary tissue biopsy samples were measured. Compared with CT, RO and PA increased forage intake. Compared with CT, RO increased concentrate intake, the value being intermediate for PA. Compared with CT, RO increased milk yield (+2.0 kg/d) and decreased milk fat and protein content (-3.8 and -1.2 g/kg, respectively), whereas PA increased milk fat content (+4.1 g/kg). Compared with CT and RO treatments, PA increased milk fat yield (+179 g/d) and 3.5% fat-corrected milk and energy-corrected milk output (+2.8 and +2.3 kg/d, respectively), and thus improved feed efficiency (+7.3%). Compared with CT treatment, RO increased milk contents of the sum of >C16 FA, monounsaturated FA, polyunsaturated FA, trans FA, and n-3 FA, whereas PA decreased these FA contents (except n-3 FA) and also decreased n-6 FA. The variations in milk fat yield and content and FA secretion at wk 9 were not associated with modifications in mammary expression of 10 genes involved in major lipid pathways, except for the transcription factor PPARG1, which tended to be higher in PA versus RO treatment. This study demonstrated that PA improved milk fat yield and feed efficiency compared with RO and suggests that factors other than gene expression, such as substrate availability for mammary metabolism or other levels of regulation (transcriptional, posttranscriptional, translational or posttranslational), could play a key role in milk fat and FA responses to changes in diet composition in cows.

Erysipelas of the right arm due to Bordetella trematum: a case report

Background

Bordetella trematum is unknown to most clinicians and microbiologists. However, this Gram-negative opportunistic bacterium can be responsible for ulcer superinfection but also bacteremia and sometimes death by septic shock.

Case report

We report the case of erysipelas due to B. trematum with bacteremia in an immunocompromised 88-year-old Caucasian patient.

Conclusion

In immunocompromised patients, unusual microbial agents such as B. trematum can be responsible for cutaneous and systemic infections, requiring specific antibiotic therapy. Therefore, clinicians should be aware of the need for specific bacterial identification such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S ribosomal RNA sequencing in the context of atypical evolution of erysipelas in such patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13256-021-02896-1.

Practice guidelines for intramuscular injection in mental health: A delphi method

Introduction

Intramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental health

Objectives

To assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.

Methods

A two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile Range

Results

From the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.

Conclusions

This study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectives

Disclosure

No significant relationships.

The levonorgestrel intrauterine system for prevention of endometrial cancer in women with obesity: A cost-effectiveness study

OBJECTIVE

To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity.

METHODS

A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars (CAD) per year of life saved. One-way and two-way sensitivity analyses were performed.

RESULTS

The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than $66,400 CAD ($50,000 US dollars) per year of life saved. The strategy becomes cost-effective if the LNG-IUS is inserted at age 57 (strategy #2), at age 52 for strategy #3, at age 51 for strategy #4 and at age 45 for strategy #5, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality.

CONCLUSION

The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity.

Accurate Measurement of the Electron Antineutrino Yield of ^{235}U Fissions from the STEREO Experiment with 119 Days of Reactor-On Data

We report a measurement of the antineutrino rate from the fission of ^{235}U with the STEREO detector using 119 days of reactor turned on. In our analysis, we perform several detailed corrections and achieve the most precise single measurement at reactors with highly enriched ^{235}U fuel. We measure an IBD cross section per fission of σ_{f}=(6.34±0.06[stat]±0.15[sys]±0.15[model])×10^{-43}  cm^{2}/fission and observe a rate deficit of (5.2±0.8[stat]±2.3[sys]±2.3[model])% compared to the model, consistent with the deficit of the world average. Testing ^{235}U as the sole source of the deficit, we find a tension between the results of lowly and highly enriched ^{235}U fuel of 2.1 standard deviations.

Determinants of doctors' antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care

INTRODUCTION

Notwithstanding high prevalence of presumably bacterial infections in elderly persons (EP) in palliative care (PC), there exists no recommendation on the role of antibiotic therapy (ABP) in this type of situation.

OBJECTIVE

To describe the determinants of antibiotic prescription by general practitioners (GP) and by doctors practicing in institutions (DPI) for patients>75 years, in end-of-life situations in PC.

METHOD

Descriptive investigation by anonymous self-administered questionnaire disseminated in France by e-mail.

RESULTS

A total of 301 questionnaires analyzed: 113 GP, 188 DPIs. The latter were mainly geriatricians (69, 36.6%) and infectologists/internists (41, 21.8%). Sixty-three (55,75%) GPs and 144 (78.7%) DPIs stated that they had prescribed antibiotics. Practice in "EHPAD" retirement homes or intensive care was often associated with non-prescription of antibiotics. Age, PC training and number of patients monitored bore no influence. Family involvement in decision-making was more frequent for GPs than for DPIs. The main purpose of antibiotic therapy was to relieve different symptoms (fever, respiratory congestion, functional urinary signs). Most of the doctors (81%) had previously encountered complications (allergy, adverse effect), which represented the main causes of treatment discontinuation.

CONCLUSION

Antibiotic use in end-of-life EPs in PC seems frequent. In accordance with the principle of beneficence, its goal of often symptom-related; that said, in the absence of scientific data, antibiotic prescription in end-of-life situations should be individualized in view of observing the other ethical caregiving principles (beneficence, non-maleficence, justice, patient autonomy) and re-evaluated daily.

On-call duties in hospital pharmacies: National survey and elaboration of a training program for pharmacy residents

OBJECTIVES

During their residency, pharmacy residents are required to attend a hospital on-call program in order to insure the continuum of care for inpatients. This activity is subject to risks, and requires a prior training. Our aim was to develop and to optimize such a training program.

METHODS

To this end, we first established a baseline study of the existing training methods in our hospital and those in the different hospitals of France in which pharmacy residents realize in-house on-call duties, associated with an identification of both pharmacists and students' needs in our institution. These preliminary studies were used to create a transversal, structured and harmonized training program.

RESULTS

The results of our national survey highlighted great disparities of training between the establishments and point out the lack of structure, organization and harmonization of the training, which residents expected to be improved. Our training program contains 3 parts: initial theoretical training, initial practical training and continuous training. Beyond the harmonization of the theoretical training's materials between the different sectors of the pharmacy, new tools were introduced like an in-house on-call duty notebook complementary to trainings adapted to note taking, simulation's workshops and interactive quizzes. The training was gradually implemented in our hospital pharmacy, in collaboration with the pharmacists of the different activity sectors.

CONCLUSIONS

The next steps of our work will be to assess pharmacists and pharmacy residents' satisfaction about our program and its efficacy.

Impact of individual social deprivation on environmental risk perception by French pregnant women

Background

Individual social deprivation (ISD) can have significant impact on the life conditions. However, few studies explored the impact of ISD on the preventive behaviors adopted by pregnant women (PW) in relation to exposure of chemicals.

AIM

This study aims to describe the link between ISD and the perception of chemical and environmental risks.

Methods

A cross-sectional survey was performed among PW present in maternity hospitals in Auvergne (France). Face-to-face interviews with a standardized questionnaire were used to collect anonymously the data (socio-demographic characteristics, smoking behaviors, perception of environmental risks (PER Score based on Likert scale ranking from 0 to 10), individual social deprivation (by EPICES score)). Statistical analysis (univariate analysis - logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

300 PW (29±5 years old) were included. The majority of PW reported being aware of the risks associated with chemicals. The PER Score is estimated at 6.3±1.8. It was significantly associated with parity and trimester of pregnancy, and inversely linked to age of PW. The EPICES Score was 19.9 ±17.8 (rank: 0-85). With a precariousness threshold of 30, only a quarter of the PW were in a precarious situation. The EPICES Score was inversely related to age, smoking behaviors, and environmental risks perception. The criterion of choice of everyday products was linked to the EPICES score. 'Organic products' were mainly used by PW with EPICES Score &lt; 30 (not precarious).

Conclusions

The weight of social determinisms on environmental sensitivity highlights the need for targeted prevention. The role of health professionals in prevention and environmental health promotion is essential, especially to detect women of low socioeconomic status who may not be sensitive to media messages and prevention campaigns disseminated by health authorities.

Key messages

Perinatal health professionals must have a major role in environmental health promotion, especially for pregnant women with individual social deprivation. Perception of chemicals and environmental risks was inversely linked to the individual social deprivation (EPICES score) in this French PW population.

Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

Water-soluble carbohydrates in Patzkea paniculata (L.): a plant strategy to tolerate snowpack reduction and spring drought in subalpine grasslands

In subalpine grasslands of the central French Alps, cessation of traditional mowing promotes dominance of Patzkea paniculata (L.) G.H.Loos (Poaceae) tussocks, with high biomass but low fodder quality. Mowing limits P. paniculata abundance through the depletion of its water-soluble carbohydrate (WSC) reserves, which sustain early spring growth initiation. However, the effectiveness of mowing effects is modulated by grassland functional composition, fertilization and climate change, as WSC compounds, and notably fructans, support plant physiological responses to climate stresses such as drought or frost. To characterize the mechanisms underpinning the control of P. paniculata under global change, we tested the effects of climate manipulation (combined snow removal and drought) and management (cutting and fertilization) alone or in combination on P. paniculata WSC storage in assembled grassland communities of varying functional composition. Management and climate treatments individually decreased seasonal fructan storage, with neither additive nor synergic effects between them, primarily due to the dominance of management over climate effects. Fructan amounts were higher in individuals growing in unmanaged exploitative communities compared to unmanaged conservative communities, regardless of climate treatments, but management overrode these differences. Our findings suggest that reduction by combined snow removal and drought of P. paniculata carbon allocation to WSC storage may similarly limit its dominance to that in current mowing practices.

Short communication: Diets supplemented with starch and corn oil, marine algae, or hydrogenated palm oil differently affect selected metabolite concentrations in cow and goat milk

The objective was to investigate the effects of species (cow vs. goat) and of various dietary lipid supplements, known to modulate milk fat content, on selected metabolites and enzymes in milk and to explore their correlations with performance traits. Twelve Holstein cows and 12 Alpine goats, all multiparous and nonpregnant, and at 86 ± 24.9 and 61 ± 1.8 DIM, respectively, were fed a basal diet (45% forage + 55% concentrate) not supplemented (CTL) or supplemented with corn oil plus wheat starch [COS, 5% of diet dry matter (DM)], marine algae powder (MAP, 1.5% of diet DM), or hydrogenated palm oil (HPO, 3% of diet DM) in a replicated 4 × 4 Latin square design with 28-d experimental periods. Intake, milk production and composition, milk fatty acid profile, and plasma metabolite concentrations were previously reported. Concentrations of 9 milk metabolites [β-hydroxybutyrate (BHB), glucose, glucose-6-phosphate, isocitrate, choline, glutamate, urea, cholesterol, and free amino groups] and 2 milk enzyme activities (alkaline phosphatase and lactate dehydrogenase) were measured on d 24 of each experimental period. Dairy performance data showed marked species and diet effects on milk fat content. Irrespective of diet, cow milk was richer in alkaline phosphatase and glucose compared with goat milk (16 and 3 times more, respectively), whereas goat milk had greater urea and glucose-6-phosphate concentrations compared with cow milk (1.9 and 5.3 times more, respectively). In cows, COS decreased milk BHB and choline (-25 and -43%, respectively) compared with CTL, whereas no effects were observed in goats. The COS and MAP diets increased milk isocitrate compared with CTL in cows, but COS decreased isocitrate concentrations in goat milk. Milk choline was correlated with milk fat content in cows (Spearman r, r_S = +0.73) and goats (r_s = +0.58), and lactate dehydrogenase activity was correlated with milk somatic cell count (r_s = +0.66) in cows but not in goats. We provide evidence of different milk metabolite responses according to species and diets. Metabolites and enzymes secreted in milk may be indicators of specificities of lipid metabolism among ruminant species and may contribute to a better understanding of mechanisms regulating milk fat secretion. Changes in the concentrations of some metabolites considered minor components of milk may be valuable diagnostic tools of mammary gland and animal metabolism as well as of milk processing characteristics.

Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement

OBJECTIVES

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level.

METHODS

Based on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018.

RESULTS

A total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1-3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78-2.00) and 1.40 (95% CI 1.34-1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensity-matched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70-2.04) %/year vs 1.71 (95% CI 1.58-1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96-1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3-49.3) than in SAVR patients with IE (32.8% 95% CI 28.6-37.3; RR 1.32, 95% CI 1.08-1.60).

DISCUSSION

In a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Medical tubings in plasticized polyvinylchloride (PVC) are widely used for the infusion of medications but are known in some cases to cause content-container interactions (drug sorption and plasticizer release). The aim of this study was to assess interactions between drugs and five alternative materials to a reference plasticized PVC intravenous (IV) infusion tubing: three were PVC coextruded with polyethylene (PE), polyurethane (PU) or a thermoplastic elastomer (Styrene-EthyleneButadiene-Styrene (SEBS)) and two were SEBS or thermoplastic olefin (TPO) monolayer tubings. Diazepam and insulin were chosen as respective reference of absorption and adsorption while paracetamol acted as a negative control. The concentration of each drug was quantified with liquid chromatography to evaluate a potential loss after a static contact condition and simulated infusion at 1 mL/h and 10 mL/h dynamic condition by an electric syringe pump. A characterization of each material's surface was performed by Fourier transform infrared spectroscopy in attenuated total reflection mode (ATR-FTIR) and by measurement of surface zeta potential. Plasticizer release was quantified by gas chromatography coupled with mass spectrometry (GC-MS). For all tubings except PVC/PU, no loss of paracetamol was observed in any condition. Diazepam sorption appeared to be less important with PVC/PE, PVC/SEBS, SEBS and TPO tubings than with PVC, but was more important when using PVC/PU tubings. PVC tubings induced the least loss of insulin amongst all the studied materials. Surface analysis by ATR-FTIR highlighted the presence of a plasticizer (that could be attributed to Tris (2-Ethylhexyl) Trimellitate (TOTM)) in the coextruded SEBS layer of PVC/SEBS, which could have influenced drug sorption, probably as a consequence of a migration from the PVC layer. Coextruded PVC/SEBS and PVC/PE presented the lowest zeta potential of all studied materials with respective values of -39 mV and -36 mV and were related to the highest sorption of insulin while PVC/PU with the highest zeta potential (about -9 mV) presented the highest absorption of diazepam. Coextruded layered materials appeared to have a lower plasticizer release than PVC alone. As a conclusion, PVC/PE and thermoplastic elastomers alone or coextruded with PVC could be interesting alternatives to PVC tubings with regards to sorption phenomena and plasticizer release.

Cosmetics and pregnancy: perception of health risk by health professionals and pregnant women

Contex

During pregnancy, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products, including cosmetics. However, both pregnant women (PW) and perinatal health professionals (PHP) know still poorly this source of exposure. AIMS: The PERICOS-Quali Study aims to identify the perception of the risk associated with the use of cosmetics during pregnancy by PHP and PW.

Methodology

A qualitative survey was conducted among PHP and PW in Auvergne (France). The data were collected by semi-structured interviews with the PHP and by focus group with the PW, until saturation of the speeches, by an experienced investigator, with an interview guide. The interviews were recorded, the verbatim was transcribed and subjected to a thematic analysis with the N-VIVO v11 software.

Results

12 PHP (5 midwives, 2 general practitioners and 5 obstetricians) and 24 PW were interviewed. PHP and PW considered cosmetics as wellness and body-care products. Furthermore PHP noted that during pregnancy women used more often organic products, moisturizers or anti-stretch marks, and reduced the use of perfumes, deodorants. In the absence of recommandations based on Evidence-Based Medecine, PHP and PW considered the risk related to cosmetics as not major. The PHP (especially midwives) reported giving advice to comfort the pregnant women; their positioning was not to prohibit the use of cosmetics during pregnancy. PW did not identify PHP as reliable sources of information about cosmetics.

Conclusions

PHP are seeking for tools to help them to better advice PW. And PW would like also to have pertinent advices about cosmetics to make a reasoned choice.

Key messages

Health education about use of cosmetics during pregnancy is necessary. Pregnant women and health professionals don’t perceive health risk linked to cosmetics.

Perception of health risk linked to environmental factors by pregnant women

Bacground

Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women.

Methodology

A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems.

Conclusions

This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors.

Key messages

Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.